radiology departments

Abstract: Radiological risk stratification and management planning are essential downstream tasks in medical imaging. Automating these tasks is challenging because clinical guideline criteria are distributed across prose, tables, and cross-referenced definitions. We present Guideline-derived Decision Graph (GDGraph), a framework that decouples guideline compilation from case evaluation. During compilation, a large language model partitions guidelines into section-based chunks, extracts local decision subgraphs with linked definitions, and aggregates related branches into an executable decision graph. During inference, a fast System One model answers localized clinical questions while deterministic traversal resolves Boolean logic, turning opaque single-pass predictions into a traceable decision path without task-specific training. Across 347 cases spanning renal cyst, adnexal mass, and thyroid nodule guidelines, GDGraph improves System One accuracy from 57.3% to 90.8%, outperforming retrieval-augmented GPT-4o (80.1%) and graph-guided GPT-4o with chain-of-thought (82.7%) at substantially lower latency and cost. The source code will be available.

Abstract: Assessment of the main pancreatic duct (MPD) from volumetric magnetic resonance cholangiopancreatography (MRCP) scans is an essential task for ductal dilatation diagnosis and pancreatic cancer analysis. However, manual assessment is affected by reader variability in which automated analysis may assist. Nevertheless, fully automated and uncertainty-aware MPD analysis from volumetric MRCP remains underexplored area of research. In this study, we propose an automatic and uncertainty-aware deep learning-based pipeline for MPD segmentation and maximum-width analysis from MRCP scans. A coarse localisation model first identifies the ductal region-of-interest, followed by a fine model that segments the MPD within the region. The dataset consists of 256 MPD-segmented MRCP scans from 69 patients. A randomly selected holdout test subset of 14 patients with 55 MRCP volumes was used for evaluation. We employed a five-model cross-validation ensemble for improved performance and uncertainty estimation. The best MPD segmentation performance was 0.634 DSC, 0.744 precision, and 0.593 recall. The mean absolute error for maximum MPD width prediction was 0.355~mm and dilated MPD ($\geq 5$~mm) was detected with 75.0\% sensitivity and 74.4\% specificity. These novel results suggest that automated MPD segmentation can be used to aid MRCP-based duct measurements.

Abstract: Recently, there has been rise in multimodal vision-language models for computer-aided diagnosis (CAD), yet their application in breast diagnosis, particularly for predicting biopsy outcomes remains limited. This study presents a multimodal vision-language approach, incorporating Grad-CAM as an Explainable AI (XAI) technique, to predict benign tumors in patients recommended for biopsy, especially those classified as BI-RADS 4 and 5. A novel multimodal framework was devel- oped using Vision Transformer (ViT) for imaging feature extraction and DeBERTa-V3-Large for textual embeddings. The model was trained and evaluated on a comprehensive in-house dataset comprising 1,632 patients, each with four mammography views and a corresponding radiology report. The features of both modalities were extracted independently and fused by late fusion before classification. Grad-CAM was used to generate visual explanations highlighting key regions influencing model predictions. The proposed model demonstrated high sensitivity 90%, 95%, 99%, and 100% with corresponding specificities of 40%, 36%, 18%, and 11%, respectively. The best AUC achieved was 0.72 by multimodal approach on the test set, outperforming the image only (0.66) and text-only (0.68) baselines. The proposed multimodal architecture, enhanced with Grad-CAM, demonstrates a strong potential to identify benign tumors among high-risk patients, offering interpretable insights and thereby helping reduce unnecessary biopsies, patient anxiety, and healthcare costs.

Abstract: Despite advances in automated liver lesion segmentation, a gap remains between image-derived predictions and clinically interpretable radiology reports. Bridging this gap requires quantitative measurements that are both reproducible and traceable. We present an evidence-grounded agentic AI framework that connects liver and lesion segmentation with deterministic quantification and structured reporting. TotalSegmentator-based nnU-Net models delineate the liver, Couinaud segments, and lesions, while computational tools extract volumes, dimensions, counts, and anatomical locations. A large language model (LLM) organizes these measurements into a predefined reporting schema, with numerical consistency checks against source measurements. On 51 LiTS cases, the segmentation stage achieved a liver Dice score of 0.947, lesion sensitivity of 75.6%, and positive predictive value of 68.9%. Exploratory screening of 25,494 MERLIN reports identified 10,208 (40.0%) with liver-related abnormalities. By connecting quantitative imaging evidence with agentic report generation, this work takes a step toward human-centered medical AI that prioritizes traceability and clinical relevance.

Abstract: Early diagnosis of hepatocellular carcinoma is critical to preserve access to curative treatment options. The Liver Imaging Reporting and Data System (LI-RADS) provides a standardized framework for non-invasive diagnosis on multiphase computed tomography, based on major visual imaging features. However, these features may be difficult to assess consistently, particularly in small liver lesions. We developed dLI-RADS, an interpretable artificial intelligence method designed to estimate the probability of hepatocellular carcinoma from multiphase computed tomography images of manually segmented liver lesions, while remaining aligned with LI-RADS-related imaging concepts. dLI-RADS combines neural network-derived predictions with handcrafted quantitative imaging measurements reflecting LI-RADS major features and integrates these inputs using logistic regression. In this multicenter retrospective study, patients with multiphase computed tomography and at least one liver lesion were included, while lesions larger than 40 mm were excluded. Histology served as the reference standard for hepatocellular carcinoma, and a composite reference standard was used for non-hepatocellular carcinoma lesions. The lesion-level accuracy of dLI-RADS and LI-RADS were compared on the internal evaluation set using 10,000-repetition bootstrap non-inferiority tests, with 5% margins and significance levels. On the external test set, sensitivities were similarly compared. dLI-RADS was non-inferior to LI-RADS for lesion-level accuracy in the internal evaluation set, achieving 80% accuracy compared with 74% for LI-RADS (p = 0.04)...

Abstract: Deep learning based models accurately delineate tumours on dynamic contrast-enhanced MRI (DCE-MRI), but segmentation masks alone do not provide the rationales or reasoning used by radiologists to assess the lesion suspicion. This limits the explainability as well the clinical integration. We investigate whether clinically relevant descriptors can instead be derived from the segmentation masks and their dynamic contrast-enhancement series. We have used Breast Imaging Reporting and Data System (BI-RADS) guidelines as a structured framework. Using these guidelines we designed a BI-RADS decision tree with eight quantitative measurements using radiomics, together with the lesion size and component count, that determine the descriptors at eight nodes. Using these descriptors we generate natural-language rationale using a large language model. The model was constrained to express only the derived records from the decision tree. After applying this framework to the expert and automatic masks of each of the 1,506 cases in the MAMA-MIA dataset, we generated a reproducible corpus of 3,012 BI-RADS grounded rationales. We obtained a faithfulness score of 99.98% and a counterfactual accuracy of 99.3%, indicating that the generated rationales faithfully verbalises the measured descriptors and correctly reflects changes in the underlying record. Agreement between the descriptors from expert and automatic masks falls from 0.832 to 0.549 as mask quality falls from Good to Missed. The generated rationales are intended as draft representations for radiologist review and final sign-off rather than autonomous clinical reports.

Abstract: Multi-parametric MRI is the gold standard for neuro-oncology, yet acquiring complete 4-modality protocols may be unfeasible in real-world clinical practice. When handling missing modalities, existing automated systems force a critical compromise: robust segmenters operate as uninterpretable "black boxes" that bypass image generation, while standard synthesis models often produce blurry reconstructions lacking diagnostic reliability. To address this issue, we propose CAPS, a Clinically-Verifiable Anatomy-Prioritized Synthesis framework that reconciles computational precision with clinical transparency. Our multi-modal generative architecture is driven by a hybrid objective function (L_1 + L_AFP + L_DualDice) that explicitly enforces the preservation of deep anatomical features and strict topological boundaries, rather than relying solely on pixel-wise optimization. Evaluated comprehensively on the BraTS Adult Glioma dataset, the framework achieves superior synthesis fidelity across intensity-based metrics, and demonstrates robust downstream segmentation performance (82.38% mean Dice), successfully restoring verifiable visual context. Furthermore, the framework exhibits exceptional zero-shot cross-domain generalization, maintaining high structural fidelity across completely unseen Meningioma, Pediatric, and Sub-Saharan African cohorts without domain-specific adaptation. Finally, a blinded radiological assessment confirms that our anatomy-aware approach significantly enhances both perceived image quality and clinical utility, providing clinicians with the reliable visual evidence required to trust downstream automated workflows.

Abstract: Reducing MRI acquisition time improves patient comfort, reduces motion artefacts, and increases scanner throughput. Clinical protocols often shorten acquisitions by sacrificing spatial resolution, particularly along the slice axis. Super-resolution can recover higher-resolution images, but existing methods are typically specialised to one scale or acquisition geometry, limiting their use across heterogeneous clinical protocols. We present GSMR3D, a continuous volumetric model that reconstructs arbitrary isotropic and anisotropic resolutions with a single checkpoint per MRI contrast. It combines a learned dictionary of anisotropic 3D Gaussian prototypes with scale-conditioned frequency encoding and an exact measurement-consistency projection, keeping reconstructions consistent with the acquired low-resolution data. We train separate models on 3,731 contrast-enhanced T1-weighted and 30,254 T1-weighted brain MRI volumes from clinical and population-based cohorts. We evaluate GSMR3D against geometry-specific specialists for isotropic, in-plane, and through-plane super-resolution using reconstruction quality and downstream tasks: brain tumour segmentation, brain-metastasis detection, and brain parcellation. GSMR3D outperforms specialists at isotropic $2\times$ and achieves better LPIPS, DISTS, and FID across all geometries, although specialists retain higher PSNR in anisotropic settings. It more faithfully preserves glioma segmentations across all geometries, achieves the highest lesion sensitivity on an independent brain-metastasis cohort, and the highest brain-parcellation agreement for isotropic and in-plane reconstruction. Reconstruction takes about 6s per volume, adding little overhead relative to acquisition-time savings. GSMR3D offers a flexible approach to MRI scan-time reduction with one model per contrast across geometries while preserving information relevant to downstream tasks.

Abstract: Vision-language models (VLMs) are increasingly being applied to three-dimensional medical imaging, but their application to knee MRI remains limited, particularly for interpreting the complementary sequences used in clinical practice. We introduce Knee3DVLM, a sequence-aware VLM that uses full-volume DESS and fluid-sensitive TSE MRI to predict 57 anatomically resolved binary diagnostic targets derived from the MRI Osteoarthritis Knee Score (MOAKS) for structured reporting. We evaluated DESS-only, TSE-only, and paired DESS-TSE configurations using subject-disjoint Osteoarthritis Initiative partitions. In a held-out cohort of 1,074 examinations, the fused model achieved 72.98% average accuracy, 71.17% balanced accuracy, 78.96% mean ROC-AUC, and 78.74% macro ROC-AUC, the highest values among the three configurations. In a secondary multiclass analysis aligned with the released 3DReasonKnee cohort, Knee3DVLM was numerically higher than the strongest reported 3DReasonKnee configuration across five pathology categories. These findings support dual-sequence full-volume modeling for comprehensive knee MRI assessment.

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: While state-of-the-art automated models for medical image segmentation achieve high mean performance, they frequently suffer from localized, catastrophic failures that preclude safe clinical deployment, particularly in neuro-oncology. Interactive segmentation frameworks mitigate this by incorporating human oversight, but traditionally impose prohibitive cognitive and temporal workloads by requiring clinicians to manually search for errors. In this project, we present an efficient, Hybrid Structural-Aleatoric Human-in-the-Loop framework for glioma segmentation that bridges the gap between automated baseline performance and surgical-grade precision, achieving sub-2.0 mm HD95 on curated benchmarks while providing safety-net routing for structural failures across real-world clinical data. By extracting voxel-wise Test-Time Augmentation (TTA) uncertainty and applying hierarchical topological filtering, our method proactively isolates high-risk structural anomalies. We comprehensively evaluated our approach on a challenging out-of-distribution clinical stress-test cohort (N = 362). Operating under a simulated Human Oracle, the framework improved the Whole Tumor (WT) Dice score from 0.891 to 0.914 and reduced the 95th percentile Hausdorff Distance (HD95) from 5.82 mm to 4.76 mm. Critically for surgical safety, the system rescued severe boundary failures in the Tumor Core, reducing mean HD95 from 17.96 mm to 14.83 mm (improving absolute TC Dice to 0.356). These spatial rescues were achieved while demanding a median interactive workload of just 11.3% of the target volume. Acknowledging this as a simulated upper bound lacking real-world cognitive friction, the framework nevertheless demonstrates a highly Pareto-efficient pathway for safely deploying clinical AI.

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

Abstract: Primary bone tumors are rare but clinically aggressive neoplasms whose diagnosis from radiographs is challenged by heterogeneous morphology, subtle lesion margins, and overlapping bone structures. To address the limitations of existing single-view models, we present a dual-input, multi-task learning framework that, to our knowledge, is the first to apply bidirectional cross-modal attention between a lesion crop and the full radiograph for joint segmentation and subtype classification. Using the multi-institutional Bone Tumor X-ray Radiograph Dataset (BTXRD, n=3,746), we employ a YOLO-based detector to generate regions of interest, which are paired with full images as inputs to a dual-stream DenseNet121 architecture. Features are integrated via a novel cross-modal attention fusion strategy, refined by Hierarchical Multi-scale Feature Fusion, effectively balancing fine-grained lesion detail with global anatomical context. Evaluated on a held-out patient-level test split, the model demonstrates superior performance over single-input baselines, achieving an overall Dice Similarity Coefficient of 0.896 and a macro-averaged classification F1-score of 0.928. Notably, the system exhibits exceptional sensitivity for malignant osteosarcoma (AUC 0.999), validating the potential of dual-stream context modeling to support radiologists in accurate, early decision-making.

Abstract: We present NV-Reason-CT, a generative vision--language model for chest and abdominal CT combining native 3D visual encoding with radiologist-guided reasoning. The model couples a native 3D vision transformer with a language model, passing all visual tokens and their explicit 3D coordinates into language decoding without further spatial token merging. This retains volumetric spatial information within the vision encoder and through the language model's positional encoding during joint processing with text. We train on a curated corpus of approximately 550,000 multimodal instruction examples from 70,111 unique CT image inputs, combining standardized reports, abnormality-focused and anatomy-specific questions, multi-turn interactions, and radiologist-authored reasoning from recorded and transcribed expert CT interpretations. Expert annotations provide direct supervision and guide additional report-grounded synthetic reasoning. End-to-end supervised fine-tuning (SFT) is followed by Group Relative Policy Optimization (GRPO), with verifiable rewards over chest and abdominal abnormality sets. The model supports abnormality classification, report generation, and interactive reasoning with reviewable observations, differential diagnoses, and uncertainty. Evaluation spans public CT benchmarks and a held-out NIH cohort. On CT-RATE, NV-Reason-CT achieves a macro-F1 of 0.614 and macro-AUROC of 0.871 without a task-specific classification head; generated reports achieve a report-derived macro-F1 of 0.592. In a preliminary study with expert radiologists, AI-assisted review received favorable confidence ratings and was associated with a 50% reduction in average reported interpretation and reporting time. We release the model and training code to support reproducible research on explainable AI for volumetric medical imaging.

Abstract: We developed an anatomy-aware deep learning framework to synthesize post-contrast breast MRI from pre-contrast images, emphasizing tumor and background parenchymal enhancement (BPE) regions. This retrospective study included 649 patients with 6,251 paired pre-contrast and post-contrast images. The framework integrates breast mask consistency, lesion-region supervision, and BPE-region supervision into an image-to-image translation model. Evaluation included quantitative image quality metrics, a reader study with two breast radiologists, and downstream Ki-67 classification. The proposed method outperformed Pix2Pix, Pix2PixHD, diffusion-based synthesis, and mask-supervised baselines in whole-image and regional evaluations. Ki-67 classification showed no statistically significant performance differences across real- and synthetic-image training and testing settings, although this does not establish equivalence. These findings suggest that anatomy-aware supervision improves synthesis fidelity and support further investigation of synthetic post-contrast MRI for contrast-free imaging workflows.

Abstract: X-ray is medicine's most widely used imaging modality, yet remains among its least quantitative. Unlike volumetric modalities like CT or MRI, X-ray collapses 3D anatomy into a 2D projection, causing structures to overlap and anatomical boundaries to be ambiguous, even to experts. As a result, labeling X-ray databases for training general-purpose segmentation systems is impractical, leaving morphometric and functional X-ray analysis confined to narrow anatomical regions and applications. To this end, we present FleXray, a generalist model for anatomical segmentation across the entire body in clinical X-rays. Instead of curating large, manually annotated X-ray datasets, we build a scalable, physics-based generative X-ray data engine. Using existing 3D whole-body CT segmentation datasets and generative image-editing models, we simulate fully-annotated 2D X-rays with diverse appearances, physiological properties, and imaging geometries. Trained on these simulations, FleXray accurately segments 60 anatomical structures across unseen research datasets and in-the-wild X-rays. We further show that FleXray makes X-rays directly amenable to quantitative analysis, enabling automated measurements for disease grading, robust navigation during X-ray-guided interventions, and data-efficient learning of pathological targets. We release the model, code, a full-body X-ray segmentation dataset, and a local, easy-to-use browser-based tool at https://flexray.csail.mit.edu .

Abstract: Recent advances in Artificial Intelligence (AI)-powered Computer-Aided Diagnosis (CAD) systems have substantially improved breast cancer screening, diagnosis, and prognosis. Comparatively, postradiotherapy outcome prediction using paired longitudinal mammograms has received considerably less attention. This is largely due to the limited availability of well-annotated longitudinal datasets. Longitudinal mammograms, coupled with paired pre- and post-treatment information, provide a unique opportunity to characterize treatment-induced breast tissue changes following radiotherapy. The resulting learned representations can serve as a valuable asset for advancing personalized radiotherapy planning and post-treatment management. In this context, we propose Mammo-LIFE, a patient-level multimodal framework for post-radiotherapy outcome prediction that combines longitudinal mammographic features with patient-level clinical variables. The imaging branch processes paired pre- and post-treatment mammograms acquired from the four standard views using a mammography-specific encoder adapted via Low-Rank Adaptation (LoRA). Within each view, preand post-treatment representations are explicitly compared through a longitudinal comparison module to capture treatment-related changes. The resulting view-level embeddings are then aggregated using learned view-attention pooling to form a unified patient-level mammographic representation. Selected clinical variables are subsequently combined with the image-derived prediction probability through a late-fusion strategy. To evaluate the effectiveness of combining paired longitudinal mammograms with clinical information, experiments were conducted on an in-house clinical cohort using patient-level stratified five-fold cross-validation.

Abstract: Objectives: Quantitative assessment of infarct hypodensity on non-contrast computed tomography (NCCT), including net water uptake (NWU), requires manual or semi-manual lesion delineation, often guided by CT perfusion or diffusion-weighted MRI, limiting clinical applicability. Automated segmentation on NCCT could enable efficient biomarker extraction such as NWU but remains challenging across heterogeneous multicenter data. This study aimed to develop and externally test a domain-aware deep learning framework for ischemic stroke segmentation on NCCT and assess its suitability for NWU quantification. Materials & Methods: In this retrospective multicenter study of 801 patients from four datasets, an nnU-Net-based model was trained on NCCT scans from the University Medical Center Hamburg-Eppendorf and the Acute Ischemic Stroke Dataset. To adapt to new domains, the model was fine-tuned on target-domain subsets from Boston (n=11) and ISLES (n=75), with evaluation on held-out cases not used for fine-tuning. Automated segmentations and NWU values were compared with expert references. Results: For lesions $\geq$ 30 mL, median Dice was 0.68 (Boston) and 0.56 (ISLES). Including smaller lesions, which predominated in ISLES, median Dice was 0.54 (interquartile range [IQR] 0.30-0.70) for acute lesion segmentation (Boston dataset) and 0.20 (IQR 0.03-0.41) for NCCT lesion segmentations when compared to post-treatment infarct (primary target of the ISLES challenge). Automated NWU mean absolute error was 1.37 percentage points (SD 1.61, Boston). Conclusion: Target-domain adaptation supported NCCT-only infarct segmentation across heterogeneous external cohorts, although performance varied across domains. The approach enabled low-error NWU quantification from baseline NCCT without advanced imaging, supporting further prospective clinical evaluation.

Abstract: Cardiovascular disease (CVD) remains the leading cause of death among women, yet cardiovascular risk assessment often relies on clinical variables that may be missing, outdated, or unavailable in routine care. Screening mammography offers an opportunity for opportunistic cardiovascular risk stratification because it is routinely acquired and contains vascular features, including breast arterial calcifications (BAC), that are associated with cardiovascular risk and events. We evaluate whether mammography specific foundation models, originally pretrained for breast cancer-related tasks, can transfer to cardiovascular risk prediction without cardiovascular specific supervision or explicit BAC annotation. We constructed a 5-year major adverse cardiovascular event (MACE) cohort of 22,497 women linked to electronic health record outcomes, including 500 events (2.22% prevalence). The foundation models achieved AUROCs of 0.823 and 0.822 substantially exceeding an age-only model (AUROC 0.765), despite using only the screening mammogram as input, with no clinical variables. Both foundation models evaluated assigned substantially higher predicted risk to patients with radiologist-documented BAC, despite BAC never being used as a training label, and showed activation patterns consistent with vascular findings. Together, these findings suggest that mammography foundation models can recover clinically relevant cardiovascular risk information directly from mammographic pixels and suggest that screening mammography may provide an opportunistic source of cardiovascular risk information to complement conventional clinical assessment without additional imaging. Code is available in https://github.com/PauFeld/MammoCVD

Abstract: We present CirrGuide, a deep cascaded framework for cirrhotic liver segmentation and severity classification. Cirrhosis causes progressive structural changes in the liver and can lead to serious clinical complications, making severity assessment important for disease monitoring and treatment planning. However, severity classification is challenging because imaging patterns are often subtle, spatially variable, and similar across adjacent stages. CirrGuide addresses this by explicitly linking localization with classification. A ResNet50 encoder with an Attention U-Net decoder first predicts a soft cirrhotic liver mask, which is then used as an anatomical prior in a ResNet50-based classification branch. This branch combines global multi-scale features with mask-guided attention-pooled regional features to classify Mild, Moderate, and Severe cirrhosis. On the official CirrMRI600+ T2-weighted (T2W) 2D split, CirrGuide achieves 89.83% Dice and 84.14% mIoU for segmentation, 69.58% accuracy and 61.55% macro F1-score for severity classification. Compared with segmentation-only, classification-only, and multi-task baselines, CirrGuide improves both localization and severity classification, demonstrating the benefit of using predicted cirrhotic liver masks as anatomical priors for cirrhosis analysis.

Abstract: Purpose: To develop and evaluate TotalSynth, a reusable pretrained framework for whole-body synthetic CT (sCT) generation from MRI and cone-beam CT (CBCT) images. Materials and Methods: In this retrospective technical study, the dataset was assembled between 2020 and 2026 from SynthRAD challenge data, four prostate cohorts, and BIC-MAC. After registration quality control, 1450 of 1800 public challenge pairs were retained; 350 were excluded for insufficient registration quality or major source/CT mismatch. The corpus also included 84 additional prostate MRI/CT and 60 external BIC-MAC MRI/CT cases. Three 5-fold model families were evaluated with image-domain, anatomy-aware, registration-based, and uncertainty metrics. Age and sex were not consistently available across public datasets. Results: The released MRI-to-CT model achieved an overall MAE of 67.49 HU, SSIM of 0.920, and PSNR of 29.28 dB. The CBCT-to-CT model achieved an overall MAE of 53.55 HU, SSIM of 0.939, and PSNR of 32.09 dB. The unified model maintained similar performance on MRI inputs (MAE, 67.68 HU) and CBCT inputs (MAE, 54.22 HU). On external BIC-MAC data, MRI-to-CT MAE was 100.91 HU without fine-tuning and 62.21 HU after fine-tuning. Conclusion: TotalSynth provides reusable MRI- and CBCT-based CT synthesis models with broad anatomical coverage, while external evaluation highlights the need for local validation and optional fine-tuning under domain shift.

Abstract: The heightened prevalence of respiratory disorders, particularly exacerbated by a significant upswing in fatalities due to the novel coronavirus, underscores the critical need for early detection and timely intervention. This imperative is paramount, possessing the potential to profoundly impact and safeguard numerous lives. Medically, chest radiography stands out as an essential and economically viable medical imaging approach for diagnosing and assessing the severity of diverse Respiratory Disorders. However, their detection in Chest X-Rays is a cumbersome task even for well-trained radiologists owing to low contrast issues, overlapping of the tissue structures, subjective variability, and the presence of noise. To address these issues, a novel analytical model termed Exponential Pixelating Integral is introduced for the automatic detection of infections in Chest X-Rays in this work. Initially, the presented Exponential Pixelating Integral enhances the pixel intensities to overcome the low-contrast issues that are then polar-transformed followed by their representation using the locally invariant Mandelbrot and Julia fractal geometries for effective distinction of structural features. The collated features labeled Exponential Pixelating Integral with dually characterized fractal features are then classified by the non-parametric multivariate adaptive regression splines to establish an ensemble model between each pair of classes for effective diagnosis of diverse diseases. Rigorous analysis of the proposed classification framework on large medical benchmarked datasets showcases its superiority over its peers by registering a higher classification accuracy and F1 scores ranging from 98.46 to 99.45% and 96.53-98.10% respectively, making it a precise and interpretable automated system for diagnosing respiratory disorders.

Abstract: Reconstructing volumetric Computed Tomography (CT) from a single 2D chest radiograph (CXR) is an ill-posed inverse problem, further complicated by the scarcity of paired CXR-CT training data. Prior approaches address this by training on Digitally Reconstructed Radiographs (DRRs), which are synthetic projections derived from CT volumes. However, the domain gap between DRRs and real CXRs limits generalization, often resulting in coarse or anatomically inconsistent reconstructions when applied to clinical images. To address this challenging problem, this study introduces a Multi-Pass Multi-View Blended Learning framework for synthesizing high-fidelity volumetric CT directly from real chest X-ray (CXR) images. The proposed approach progressively decomposes the synthesis task into two distinct, complementary learning stages. Stage 1 is an unsupervised CXR-to-DRR Domain Adaptation, while Stage 2 includes three passes, namely, (a) supervised DRR-to-CT Transformation, (b) unsupervised Multi-View Slice Refinement, followed by (c) Progressive Transfer Learning (PTL). With such a blended learning paradigm, the proposed approach mitigates the synthetic-to-real domain gap while enhancing both the structural integrity and anatomical detail of the final output. On the LIDC-IDRI dataset, where paired DRR-CT ground truth is available for quantitative evaluation, the proposed method improves upon prior methods by up to 14% in PSNR and 7.6% in SSIM. The framework successfully generates structurally consistent and anatomically realistic high-fidelity CT volumes from real CXRs, marking a significant advancement toward clinical viability of CT reconstruction from standard radiographic images.

Abstract: Purpose: Accurate CT protocol selection is critical for diagnostic quality and patient safety, yet the current process is manual, time-consuming, and prone to inconsistencies. Prior Machine Learning methods using keywords or bag-of-words lack contextual understanding and perform poorly on rare protocols. We propose a decision support system using large language model (LLM) features to recommend protocols from free-text clinical indications, capturing clinical nuance and phrasing variation for more consistent, efficient selection. Methods: In this REB-approved retrospective study, 285,123 chest CT imaging requests from a large academic medical center (2017-2024) were split into training (228,099, 80%) and held-out test (57,024, 20%) sets. Each request included procedure names, clinical indication, HIS comments, and the selected protocol. Clinical text was embedded using a fine-tuned LLM, Meta's LLaMA-3.1-70B; these features input a logistic regression classifier predicting 18 protocol labels (e.g., PE, LDCT). Results: The pipeline achieved a weighted precision of 0.84, weighted F1-score of 0.81, and overall accuracy of 79% across 18 CT protocols. On 300 independent cases with expert consensus, the LLM reached an overall accuracy of 80% versus 83% for radiologists, with no significant difference (p = 0.263). Performance was comparable across most classes, with the LLM exceeding radiologists for some challenging categories, and entropy analyses indicated more balanced protocol use, suggesting reduced variability. Conclusion: An LLM-based recommendation system can leverage general knowledge from a large natural-text corpus to accurately assign chest CT protocols from free-text imaging requests, and may serve as a viable foundation for protocol recommendation tools where inputs require language understanding.

Abstract: Medical imaging artificial intelligence (AI) is commonly developed as separate mappings from radiographs to diagnostic outputs or from clinical descriptions to generated images, although both arise from the same underlying radiographic state. A world-model formulation instead seeks to learn an internal representation of this state that can support both clinical readout and conditional simulation of radiographic observations. Here we introduce MedDream, a radiographic world model that learns a shared continuous latent state from paired chest radiograph-text observations for diagnostic reasoning and report-conditioned evidence generation. MedDream was pretrained on 2.65 million leakage-controlled chest radiograph-text pairs curated from 4.40 million candidates. Across eight clinical datasets and two independent reader cohorts, MedDream outperformed leading diagnostic and generative comparators. For diagnostic reasoning, MedDream showed strong generalization across disease recognition, label-scarce adaptation, severity assessment, and localization, while MedDream-supported review increased mean resident concordance with independent radiologist consensus from 56.3% to 63.0%. For evidence generation, MedDream produced radiographs that preserved clinically relevant pathology and improved downstream performance on held-out real data, with synthetic augmentation increasing external VinDr-CXR macro-AUROC from 76.4% to 81.4%. More importantly, conditioning generation on prespecified subgroup performance gaps enabled targeted evidence construction, increasing weighted F1 by 3.1 percentage points in Asian patients, whereas matched-volume unguided augmentation decreased it by 2.3 points. These findings establish radiographic world models as a path toward medical AI that learns clinically meaningful internal states for interpreting, simulating, and constructing evidence for clinical use.