radiology software developers

Abstract: Deep learning models for whole-body positron emission tomography/computed tomography (PET/CT) hold significant clinical potential for disease detection, treatment planning, and response assessment. However, the time and cost associated with expert annotations remain major bottlenecks in developing robust and generalizable models. Although self-supervised learning (SSL) has emerged as a promising approach to mitigating annotation scarcity, its application to whole-body PET/CT remains relatively underexplored due to the limited availability of large-scale datasets and the challenges associated with learning complementary cross-modal representations. To address these limitations, we curate a heterogeneous, multi-tracer, multi-institutional cohort comprising 6,531 whole-body PET/CT scans and propose LoRe-MIM (Lost-Or-Replaced Masked Image Modelling), a novel self-supervised framework designed to learn multimodal representations through masked image reconstruction. Specifically, LoRe-MIM introduces a masking strategy in which image regions are either replaced with zeros (Lost) or substituted with corresponding complementary imaging modality (Replaced), encouraging the model to capture both modality-specific characteristics and cross-modal relationships. We evaluate the learned representations across multiple downstream tasks, including multimodal PET/CT image reconstruction, patch-based classification into cancer vs. non-cancer, whole-body lesion segmentation, label-efficient training, and robustness assessment. Experimental results demonstrate that LoRe-MIM consistently outperforms the corresponding state-of-the-art baselines across these tasks, highlighting its potential as a scalable and generalizable self-supervised learning framework for whole-body PET/CT analysis.

Abstract: Tumor delineation is required for radiotherapy planning, yet automatic segmentation is limited by errors, predominantly false positives, that distort dose and increase editing time. The radiology report accompanies the scan and localizes disease at the suborgan level, but existing text-promptable models condition on short referring phrases, and most operate in 2D. We present RepConTUR, a single native-3D early-fusion multimodal model that conditions volumetric abdominal tumor segmentation on the narrative report. We extend AbdomenAtlas 3.0 to a suborgan-level promptable segmentation dataset and generate report-based VQA pairs, yielding four report-derived tasks on the same annotations: referring segmentation (RES), report-grounded segmentation (GSEG), report generation (RRG), and visual question answering (VQA). We train RepConTUR, comprising a 3D CT encoder, an early-fusion language model, and a native-3D segmentation module, jointly on the four tasks. Across liver, kidney and pancreas, RepConTUR attains the highest Dice similarity coefficient (DSC), instance-wise precision, and detection F1 among the text-promptable baselines, and adding the report raises mean precision while leaving recall comparable. Against two vision-only specialists, nnU-Net and the report-supervised R-Super, RepConTUR attains the highest value on every in-domain metric for liver and pancreas and the highest mean DSC, recall, precision, and detection F1 over the four out-of-distribution public cohorts. Ablations indicate that conditioning on the narrative report raises detection F1 from 0.499 to 0.528 within the same model, that joint GSEG training raises RES F1 from 0.450 to 0.482, and that the native-3D segmentation module raises GSEG F1 from 0.139 to 0.528 over its 2D counterpart. Code is available at https://github.com/Oncosoft-Research/RepConTUR.

Abstract: Accurate multi-organ segmentation in computed tomography (CT) is essential for computer-aided diagnosis, treatment planning, and disease monitoring. However, substantial variations in organ shape and size, together with low tissue contrast and ambiguous boundaries, complicate the modeling of heterogeneous anatomical structures. To address these challenges, we propose a Morphology-Aware Channel-Decoupled Mamba Network (MCDNet), which integrates adaptive local structural enhancement with channel-decoupled long-range modeling. Specifically, we introduce a Morphology-Aware Channel-Decoupled State-Space (MCSS) block that divides feature channels into separate processing groups, allowing differentiated structural representations to be learned within an efficient state-space framework. Within each group, a Morphology-Aware Enhancement Module (MAEM) combines deformable convolutions with channel attention to adapt local feature extraction to anatomical shape variations. Group-wise state-space modeling then captures long-range spatial dependencies, and channel gating adaptively integrates the resulting features. Experiments on the Synapse abdominal CT dataset demonstrate the effectiveness of MCDNet, achieving an average Dice Similarity Coefficient of 81.61% for multi-organ segmentation.

Abstract: Accurate lung tumor segmentation in computed tomography (CT) is essential for treatment planning, response assessment, and quantitative imaging analysis. However, 3D lung tumor segmentation remains challenging because tumors occupy only a small portion of the whole volume and exhibit heterogeneous appearances across anatomical locations. In patch-based training and sliding-window inference for 3D medical image segmentation, location-dependent heterogeneity is further amplified because cropped image patches provide limited global anatomical context, making it difficult for a model to adapt its feature processing according to the anatomical region from which each patch is extracted. To address this limitation, we propose an Anatomical Prior-guided Routing Module (APRM) for lung tumor segmentation. For each image patch, we obtain anatomical prior information of regional occupancy and deterministically select an anatomical routing gate. The selected gate then performs sparse feature routing over a shared expert adapter pool, enabling anatomy-specific feature adaptation while sharing expert capacity across regions. We evaluate APRM on two datasets with various backbone networks and demonstrate consistent improvements over baseline models. Furthermore, feature visualizations show that APRM produces different feature responses depending on patch location, indicating that the proposed routing mechanism effectively adapts feature processing according to anatomical context.

Abstract: Positron Emission Tomography (PET) provides important metabolic information for tumor detection and staging but remains significantly less accessible than Computed Tomography (CT) due to its high cost, infrastructure requirements, and reliance on injected radioactive tracers. CT-to-PET image translation using generative models aims to address this disparity, yet state-of-the-art diffusion-based methods are limited by the scarcity of paired training data. To overcome this, we propose a domain-adapted latent diffusion framework that transfers natural-image priors using a relatively small dataset of 21,930 paired CT/PET slices, incorporating a signed power transform to resolve extreme intensity sparsity in PET data. Compared to CPDM, a state-ofthe-art baseline for CT-to-PET image translation, our approach yields superior performance in pixel-wise reconstruction and localized tumor fidelity, demonstrating effective transfer of natural-image priors to the medical domain. We further provide a systematic analysis of evaluation metric reliability for sparse PET data, showing that standard full-image metrics can be misleading indicators of translated image quality, and propose background-filtered and mask-restricted metrics as more clinically meaningful alternatives.

Abstract: Objective. Deformable image registration remains challenging because corresponding anatomy may exhibit different intensity relationships. Hand-crafted modality-robust descriptors such as Modality-Independent Neighborhood Descriptor with Self-Similarity Context (MIND-SSC) and features from pretrained vision encoders provide distinct representations for correspondence estimation, but how they should be combined remains unclear. We investigate whether tighter integration improves registration over a sequential, scale-separated design. Approach. We introduce FlexiMIND, a training-free and label-free two-stage framework in which frozen FlexiCT-2D encoder features establish contextual correspondence and MIND-SSC refines the deformation within ConvexAdam. Five alternative feature-coupling strategies were evaluated under a protocol across CT-CT (DIR-Lab 4DCT 4DCT, 10 cases), MR-MR (ACDC, 50 patients), and MR-CT (Learn2Reg Abdomen MR-CT, 8 pairs) registration. Performance was assessed using target registration error (TRE), Dice similarity coefficient (Dice), SDlogJ, and local folding. Main results. FlexiMIND achieved a TRE of 1.27 mm on DIR-Lab 4DCT, a DSC of 0.807 on ACDC, and an organ-averaged DSC of 0.825 on Abdomen MR-CT. Across 15 coupling-strategy dataset comparisons, only four outperformed the reference method, with a maximum absolute improvement of 0.0043 in Dice, whereas degradation reached 20.6 % in TRE and 37.9 % in Dice. Changes in registration accuracy were closely associated with changes in deformation-field regularity, and strategies that better preserved regularity generally remained closest to the reference performance. Landmark-level analysis showed that the pretrained encoder stage primarily reduced large correspondence errors rather than uniformly improving local precision. Code is available upon acceptance at https://github.com/mosaf/FlexiMIND.

Abstract: Automated prostate lesion detection from diffusion-weighted MR imaging (DWI) conventionally relies on reconstructed images and does not fully use all acquisition information. We present an end-to-end network that uses complex multicoil DWI data and coil sensitivity information for prostate lesion segmentation. We included 269 fastMRI prostate examinations with additional voxel-level lesion annotations. Of these, 64 examinations contained PIRADS 4 or 5 lesions. The proposed network, VarNet-Seg, consists of a k-space variational network (VarNet) with six variational cascades and an image-space 3D segmentation U-Net. Comparator models used the same segmentation architecture with fully coil-combined images (CC-Seg), fixed root-sum-of-squares reconstruction (RSS-Seg), or fixed SENSE reconstruction (SENSE-Seg). We performed ablations with end-to-end training and data consistency (DC) enabled or disabled. We evaluated lesion segmentation using Dice and patient-level detection using AUROC in five-fold cross-validation with full sampling, simulated undersampling, added noise, or both. VarNet-Seg achieved the highest Dice at every undersampling level. At eight-fold acceleration, Dice was 0.22 for VarNet-Seg, 0.14 for SENSE-Seg and 0.16 for VarNet-Seg (no DC). The paired difference from SENSE-Seg was 0.08 (95% CI, 0.04-0.11). With full sampling, VarNet-Seg and RSS-Seg performed similarly (0.40 vs 0.39). Patient-level AUROC decreased from 0.75 with full sampling to 0.63 at eight-fold acceleration; corresponding RSS-Seg AUROCs were 0.76 and 0.64. The proposed multicoil network improved prostate lesion segmentation under simulated undersampling compared to conventional models. Matched ablations supported contributions from both end-to-end training and data consistency. Prospective evaluation is needed to establish whether this approach can be used clinically in accelerated prostate DWI.

Abstract: Organizing radiology reports into independently generated units offers a way to generate fine-grained clinical content and bind it to visual evidence. However, existing methods typically adopt generation-unit structures not directly specified in natural reports or their annotations, introducing additional modeling compromises. We propose RadCarve, which instead defines generation units directly from the anatomical region sets in existing statement-region correspondences, unifying unit formation with visual evidence selection. RadCarve's planner uses composition-specialized query banks to jointly predict unit existence and region composition from the image, iteratively refining both with regional evidence aggregated according to current membership predictions. The generator independently produces each unit's text conditioned on the joint visual evidence of its predicted region set. Compared with strong baselines, RadCarve improves CXRFEScore by 9.4% in unit generation given region sets and achieves 2.4 times the end-to-end binding F1. It also achieves leading report-generation results on Chest ImaGenome and PadChest-GR, using fewer than one-sixth as many parameters as large-scale baselines.

Abstract: Radiologists interpret follow-up chest X-rays by comparing current and prior examinations to identify new, resolved or progressing findings. Most report generation systems either omit this longitudinal context or fuse prior features without distinguishing interval changes from anatomy that remains stable over time. We propose CPVB-RG, a prior-aware framework that combines current and prior radiographs with available clinical text. Its Cross-Prior Visual Bridge (CPVB) contains Progression-Guided Focus Attention (PGFA) and two Cross-Attention units. PGFA is designed to contrast progression-difference attention with shared-spatial attention, aiming to reduce invariant responses whilst retaining coarse spatial correspondence between examinations. The Cross-Attention units then connect the resulting longitudinal visual evidence with clinical semantics. CPVB-RG is trained in two stages, using prior-guided image-text alignment followed by autoregressive report generation with a lightweight language decoder. Experiments on MIMIC-CXR and IU X-Ray show consistent improvements across language and clinical metrics. On MIMIC-CXR, CPVB-RG achieves 0.2847 F1RadGraph and 0.6692 VLScore, with statistically significant gains over the closest decoder-matched prior-aware baseline. These results support the effectiveness of the proposed difference-aware and spatially guided fusion design for prior-aware chest X-ray report generation.

Abstract: Deep learning segmentation models for pediatric oncology are often trained on small, single-center cohorts, whereas much larger datasets exist for adult diseases, such as kidney cancer. Whether models trained on adult renal lesions generalize to pediatric Wilms tumors remains unclear. We trained a segmentation model on single-sequence T1- or T2-weighted adult kidney MRI and evaluated it on a held-out adult test set and a pediatric Wilms tumor cohort, where it was compared with a pediatric-specific nnU-Net. Segmentation performance was quantified using the Dice similarity coefficient (DSC) and 95th-percentile Hausdorff distance. On the adult test set, the model achieved a median DSC of 0.86 for renal lesions. On the pediatric cohort, the adult-trained model achieved a median DSC of 0.85 compared with 0.90 for the pediatric-specific model. Despite differences in age, anatomy, and tumor type, the adult-trained model showed promising performance on pediatric Wilms tumors, with only a modest difference in median DSC compared with the pediatric-specific model. However, non-inferiority could not be shown, highlighting the value of pediatric training data. In future work, a fine-tuning strategy could be explored.

Abstract: Generative super-resolution (SR) can recover sharp detail in computed tomography (CT) images from severely downsampled observations, but the missing high-frequency content is not uniquely determined by the low-resolution input. Consequently, visually plausible reconstructions may contain anatomically unsupported vascular detail, such as missing, spurious, or incorrectly connected vessels. To overcome this challenge, we introduce VascuSR, an iterative anatomy-aware diffusion framework that combines image reconstruction with explicit 3D vascular guidance. First, to provide richer anatomical guidance, we use an explicit 3D vascular representation that captures structural information beyond individual slices. This representation also simplifies vascular refinement by allowing a lightweight 3D generative refiner to focus on vascular structure rather than complex CT appearance. Second, to guide slice-wise SR, a lightweight anatomy controller injects the refined structure into the diffusion decoder, while iterative feedback updates this guidance from each new SR volume. On re-annotated MSD Task08 and HVM datasets, VascuSR outperforms interpolation and learning-based SR baselines in segmentation accuracy (Dice and clDice) and 3D vascular structure (connectivity and mean centerline distance), while maintaining image quality comparable to its SR backbone. Compared with learning-based baselines, VascuSR reduces class-averaged connected-component counts by over 20% on both datasets and mean centerline distance by over 10% on MSD.

Abstract: Chest X-Ray (CXR) is a primary modality for diagnosing pulmonary diseases, yet the overlap of bony structures often obscures critical radiographic findings, increasing the risk of diagnostic uncertainty. While Dual-Energy Subtraction (DES) is the clinical benchmark for bone suppression, its widespread adoption is primarily hindered by specialized hardware requirements and increased radiation exposure. Recently, diffusion-based generative models have shown promise for this task, yet they are still constrained by reconstruction-biased latent compression, prior-induced domain gap, and a scarcity of high-quality paired datasets. To address these challenges, we propose DeBoneDiT, a depth-driven conditional bridge diffusion Transformer architecture for efficient high-resolution bone suppression. We first introduce Depth Auto-Encoder (DAE), a structure-aware vision tokenizer for latent compression. By incorporating a multi-level depth feature loss derived from the pretrained Depth Anything V2 encoder, DAE preserves both visual fidelity and structural consistency. Second, we formulate bone suppression as a source-conditioned Brownian bridge diffusion process, leveraging CXRs as both the diffusion prior and structural guidance to narrow the source-to-target domain gap and maintain anatomical plausibility. Furthermore, we have constructed and released SZCH-X-Rays, the largest publicly available high-quality paired dataset for bone suppression to date, comprising 741 pairs of CXR and DES soft tissue images. Extensive experiments and downstream evaluation demonstrate that DeBoneDiT achieves superior bone suppression performance with reduced computational overhead.

Abstract: Pixel-level annotation for chest X-ray (CXR) lesion segmentation is expensive, making active learning (AL) essential. However, existing AL strategies fail to account for the spatial distribution of selected samples, resulting in inconsistent performance across focal (e.g., aortic calcification) and diffuse (e.g., nodules) pathologies. In this paper, we propose SPARCL (Spatially Adaptive Regional Coverage for Active Learning) to dynamically balance predictive uncertainty with cumulative spatial coverage. By employing a concave coverage function, SPARCL imposes diminishing returns on previously annotated regions, naturally directing the annotation budget toward under-labeled areas. Furthermore, an entropy gate reverts the algorithm to standard uncertainty sampling when spatial variation is absent. This coverage objective is monotone submodular, guaranteeing near-optimal greedy batch selection. To address how aggregate metrics like Dice obscure regional failures, we further introduce two metrics---Spatial Inconsistency (SI) and Performance Coverage (PC)---to quantify anatomical fairness across AL rounds. Evaluated on an in-house calcification cohort and public CXR benchmarks, SPARCL reaches 95% of fully supervised performance using only 24% of the data, compared to 29% for the best baseline. Ultimately, SPARCL ensures robust spatial reliability, surfacing regional gains that aggregate metrics miss.

Abstract: Incomplete field-of-view (FOV) diffusion MRI (dMRI) acquisitions compromise whole-brain white matter analysis by excluding brain regions from tractography and connectivity studies. While deep generative models for dMRI FOV extension have been proposed, their generalizability remains limited by the acquisition-dependent nature of dMRI, where signal intensity varies with b-value, gradient direction, and scanner protocol, and the inherent 4D complexity of the data, making it difficult to train models that transfer across sites or acquisition schemes without retraining. We propose a flow-matching generative model that extends the dMRI FOV in both the superior and inferior directions by predicting apparent diffusion coefficients (ADC) in six directions, conditioned on the two nearest acquired slices and the full-FOV T1w image to enforce both local diffusion continuity and anatomical consistency. The ADC representation decouples the model from acquisition-specific b-values and gradient directions, providing a middle-ground across protocols. The model was trained on 3,103 subjects (5,105 sessions) across five different datasets spanning diverse acquisition schemes (b = 500 and 1000 s/mm$^2$; 21--192 gradient directions), four single-shell (b = 1000) and one multi-shell (b = 500/1000). Evaluated on 299 subjects across five independent datasets spanning b = 750--1500 s/mm$^2$ and 32--90 gradient directions, with single- and multi-shell schemes unseen during training, the proposed method achieves significantly improved bundle Dice score on downstream tractography (p < 0.01).

Abstract: Radiology reports are essential for diagnostic reasoning and patient care, yet their manual preparation is time-consuming and cognitively demanding. Automatic radiology report generation (RRG) offers a scalable alternative, but existing models often produce lengthy, unstructured narratives that overlook diagnostic cues and multi-view information. We present Clinical-Knowledge Guided Disease-aware Visual-Textual Alignment for QA-Style Radiology Report Generation (CliQ-RRG), a unified two-stage framework for interpretable and clinically grounded reporting. In Stage 1, CliQ-RRG employs a Disease-aware Visual-Textual Alignment module that aligns image and text representations using predicted disease embeddings, reinforced by a Prior-Guided Attention Module (PrAM) to capture multi-view dependencies across current and prior scans. In Stage 2, GraphRAG-guided retrieval augments intermediate textual representations with graph-grounded clinical evidence, and a large language model restructures them into concise, interpretable question-answer (QA) pairs with diagnostic summaries. Experiments on two public chest X-ray benchmarks demonstrate that CliQ-RRG consistently outperforms prior methods across both lexical and clinical metrics, generating accurate and clinically coherent QA-style radiology reports. Code is available at: https://github.com/chandravardhan-singh-raghaw/CliQ-RRG.

Abstract: Recent advances in large-scale foundation models have enabled strong generalization across a wide range of clinical and research tasks in magnetic resonance imaging (MRI). However, existing vision-language MRI models remain limited in anatomy-specific localization and pathology-aware representation, particularly in real-world settings. We introduce A4-MR, a 3D vision-language foundation model trained on approximately 50,000 MRI studies comprising 491,000 series, roughly half of which are paired with radiology reports. A4-MR is designed to: (1) learn anatomy localization through large-scale pretraining with noisy labels; (2) align image and text representations at the anatomical level; and (3) learn distinct representations of healthy and abnormal anatomy. Across a diverse set of downstream tasks, A4-MR outperforms existing foundation models, including a +1.7 AUROC improvement over MedSigLIP for abnormality detection. Using a frozen encoder, A4-MR also surpasses an end-to-end task-specific MedNeXt model for knee segmentation by +1.4 Dice and performs comparably to the best task-specific model for abdominal organ segmentation on AMOS, within 0.4 Dice. Finally, without anatomical prompts, A4-MR localizes 3D anatomy comparably to MedSAM2 provided with ground-truth bounding boxes. Together, these results demonstrate that anatomy-level multimodal alignment and abnormality-aware representation learning can enable a single MRI foundation model to support localization, segmentation, and pathology-related tasks.

Abstract: False negatives remain a critical limitation of computer-aided diagnosis (CAD) systems for breast cancer screening due to delayed detection and treatment. To address this issue, we propose a counterfactual data augmentation strategy that generates healthy mammograms by "erasing" lesions from anomalous images, thereby enriching the training distribution. We train a Denoising Diffusion Probabilistic Model on BI-RADS 1 (healthy) mammograms and use a RePaint-based sampling strategy to inpaint realistic normal tissue within annotated lesion bounding boxes. The resulting healthy counterfactuals replace annotated lesion regions with realistic healthy tissue while preserving patient-specific anatomical structure, as supported by similarity metrics between real and generated images. Image realism was further assessed by radiologists and found to be consistent with the original dataset quality. We evaluate counterfactual augmentation across four representative classifier architectures: a convolutional neural network (ConvNeXt), a vision transformer (ViT), a vision-language model pre-trained on mammogram-report pairs (Mammo-CLIP) and a multi-scale attention-based multiple-instance learning framework (FPN-MIL). Experiments conducted on the VinDr-Mammo dataset show improvements in sensitivity across all architectures, particularly at 80\% fixed specificity, contributing towards more reliable CAD systems for breast cancer. Code is available at: https://github.com/ines03garcia/diffusion-based-counterfactual-generation.

Abstract: Radiology report generation can automatically generate clinical descriptions from X-ray images, thereby significantly improving the efficiency of radiologists. This task is challenging because it requires medical knowledge to accurately identify diseases and describe them in a professional manner. However, existing methods often overlook the importance of enhancing medical knowledge in describing pivotal areas, a capability that requires models to effectively extract and aggregate knowledge at multiple levels of granularity. Accordingly, we herein propose a novel and compact Efficient Multi-Granularity Knowledge Transfer (\textbf{EMGKT}) method to address the above issues. First, we encode global knowledge embeddings using a medical vision-language model, which provides contextual medical knowledge. Moreover, we devise a novel Fine-Grained Knowledge Distillation (FGKD) training task which efficiently extract fine-grained knowledge. Specifically, the FGKD training task contains teacher embeddings and student embeddings. Teacher embeddings are encoded using extra priors; while student embeddings are learned from the teacher embeddings through knowledge distillation. During inference, the student embeddings are used to enhance fine-grained knowledge while the teacher embeddings are discarded, resulting in negligible computational costs and no need for extra priors. Finally, we further develop a mixture of disease diagnosis expert classifiers to enhance knowledge extraction. The classifiers are initialized using disease embeddings and are modeled as different experts to address various granularity features. Notably, \textbf{EMGKT} can be efficiently applied to most existing methods. Extensive experiments are conducted on two widely-used public datasets and various baselines, which demonstrates the effectiveness and transferability of \textbf{EMGKT}.

Abstract: Acquiring a complete set of magnetic resonance imaging (MRI) contrasts is time-intensive and uncomfortable for patients, despite the diagnostic value of multi-contrast imaging. This motivates synthesizing missing contrasts from those already acquired, which is an inherently 3D problem requiring anatomical coherence across axial, sagittal, and coronal planes. However, fully 3D generative models are often impracti- cal under computational resources that scale cubically with volume size. We propose a unified Multi-Plane Autoregressive Diffusion (MPAD), a latent diffusion framework that achieves full-volume 3D synthesis using efficient plane-wise 2D operations while preserving volumetric coherence. A 3D autoencoder first compresses MRI scans into an isotropic 3D la- tent representation. A 2D diffusion model is then trained to reconstruct masked latent slices of the target contrast, conditioned on both source- contrast slices and unmasked target-contrast slices. During inference, we introduce plane-wise autoregressive synthesis with inter-plane priors. Slices are generated autoregressively in random order within one plane orientation to maintain intra-plane continuity, then propagated as con- ditioning priors to orthogonal plane orientations to enforce inter-plane consistency. Compared to 3D latent diffusion baselines, MPAD reduces training and inference FLOPs by 7x and 3x, respectively, while also lowering inference time and peak memory consumption. Experiments on multiple datasets demonstrate that MPAD achieves superior perfor- mance, generating high-fidelity 3D volumes and supporting one-to-many translation within a single unified model.

Abstract: Generative inpainting of brain MRI volumes is essential for synthesizing healthy tissue in pathological regions, improving the accuracy and reliability of automated downstream brain analysis applications such as image registration, brain extraction, and segmentation. However, standard 3D approaches are computationally prohibitive, while efficient 2D slice-wise methods suffer from severe inter-slice discontinuities. Furthermore, traditional models rely on conditional training, requiring task-specific learning of masked inputs. We propose a zero-shot brain MRI inpainting framework utilizing 2.5D unconditional flow priors to capture spatial context along the superior-inferior axis without the overhead of full 3D convolutions. During training, our flow matching model learns the joint distribution of adjacent axial slice triplets, modeling the manifold of healthy brain anatomy while explicitly excluding pathological regions from the loss function. At inference, the model processes the input triplets autoregressively along the depth axis. We employ the Restora-Flow solver to constrain the unconditional prior using the input mask, achieving accurate zero-shot inpainting. Evaluations show our 2.5D strategy resolves the structural discontinuities of 2D baselines, synthesizing plausible healthy tissue while maintaining volumetric consistency across the axial, sagittal, and coronal planes. As a final step, we generate and average an ensemble of multiple stochastic reconstructions to form the final prediction. Quantitative results benchmarked on the official BraTS 2026 Inpainting Challenge validation set demonstrate the effectiveness of our proposed approach, yielding an SSIM of 0.816 $\pm$ 0.112, MSE of 0.007 $\pm$ 0.005, and PSNR of 22.923 $\pm$ 4.343. Code is available at https://github.com/imigraz/brats2026-inpainting.

Abstract: Cardiac magnetic resonance imaging reconstruction aims to recover high-quality images from undersampled acquisitions, enabling faster scans while preserving diagnostic fidelity. Recent reconstruction methods are typically trained from scratch and often require large amounts of task-specific data, limiting their robustness under data scarcity and distribution shifts. In this work, we investigate whether pretrained vision foundation models can serve as effective priors for accelerated cardiac MRI reconstruction. We propose a reconstruction framework that integrates frozen and parameter-efficiently adapted visual encoders, including CLIP, BiomedCLIP, and DINOv2, within a transformer-based reconstruction architecture. Extensive experiments on the CMRxRecon2023 and CMRxRecon2024 benchmarks demonstrate that pretrained representations consistently outperform a transformer trained from scratch across multiple acceleration factors. We further evaluate performance under limited supervision and cross-dataset transfer, showing that foundation models provide superior data efficiency and generalization. While frozen representations are particularly effective in extreme low-data regimes, Low-Rank Adaptation (LoRA) yields additional gains when moderate amounts of training data are available. Among the evaluated backbones, DINOv2 achieves the strongest overall performance. These findings highlight the potential of vision foundation models as robust and transferable priors for cardiac MRI reconstruction.

Abstract: Multi-structure segmentation of the uterus is important for computer-assisted screening, diagnosis, and treatment planning of uterine diseases, where ultrasound and MRI provide complementary clinical information. However, developing a unified model across these modalities is challenging due to their substantially different image appearances, anatomical contexts, spatial resolutions, and label spaces. Moreover, existing datasets often define different segmentation targets, making joint learning challenging and potentially leading to negative transfer across heterogeneous tasks. To this end, we propose a Topology-informed Prompt-conditioned Universal Segmentation (TPUS) framework for segmenting multiple uterine structures across ultrasound and MRI. TPUS introduces a graph-based multi-dataset backbone comprising modality-specific stems and a modality-shared graph-based encoder-decoder to support modality-sensitive input adaptation, structural feature reasoning, and joint representation learning across heterogeneous uterine segmentation tasks. In addition, TPUS uses task-aware class prompts to condition the segmentation process for different datasets and label spaces, a dynamic convolutional adaptation module to generate task-specific output responses, and a topology-informed loss to encourage anatomically consistent predictions. Experiments on a uterine ultrasound dataset and a T2-weighted uterine myoma MRI dataset demonstrate that TPUS achieves Dice scores of 0.898 and 0.693 on the two held-out test sets, respectively, outperforming several generic and universal segmentation baselines. Source code can be accessed at https://github.com/YonghengSun1997/TPUS.

Abstract: Automated checks of radiology reports may rely on AI-generated checklists that leave findings unmentioned. We used reinforcement learning to train a vision-language model to fill in a 12-finding checklist from a chest radiograph without seeing the sentence under test; a separate checking model judged the sentence from the checklist. On held-out patients, a rule-based check and an independent medical checker, neither used in training, measured discrimination gains (Youden index) of 12.6% and 11.8%; only the rule-based check met the prespecified false-alarm criterion. Switching to the training format, which fixes finding order and enters unmentioned findings as absent, raised the training checker's measured gain and lowered the independent checker's, a prespecified comparison that yielded 6.2% (95% interval 2.0% to 10.5%) and, post hoc on held-out patients, 7.7%. Across 8 checking models, acceptance of a label-consistent negative statement about an unmentioned finding ranged from 1.0% to 97.0%. Labels were report-derived, not radiologist-adjudicated.

Abstract: Editing a chest radiograph requires completing the requested change while preserving unrelated content. We study a latent diffusion editor with an instruction-independent source trajectory and an instruction-conditioned editing trajectory. A learned gate mixes their post-sampler candidates at each executed step, and a separate image-space mask composites the decoded proposal with the source. On 2,400 MIMIC-derived requests, 2,244 outputs met the joint target, preservation, quality, and coverage rubric (93.5%), and target completion was 97.4%. Joint validity exceeded a matched composition-only control by 1.7 percentage points (paired patient-cluster 95% interval, 0.6--2.8). At a fixed learned mask, the learned-gate proposal improved joint validity by 1.6 points (0.8--2.4); at a fixed learned proposal, the learned mask improved it by 2.6 points (1.7--3.5). Across three training seeds, mean joint validity was 93.5% with a 0.3-point sample standard deviation. A blinded 240-request assessment yielded adjudicated joint validity of 93.3% for the full editor and 91.7% for composition only. Protected-region mean absolute error decreased from 0.0190 in the raw proposal to 0.0075 after composition. These findings distinguish recurrent-gating effects on the proposal from preservation through final composition in the assessed cohort.

Abstract: Automated report generation can ease the burden radiolo gists face when interpreting multi-sequence MRI studies. Unlike CT, MRI examinations comprise multiple sequences and imaging planes, each con tributing complementary diagnostic information. Existing methods en code a study as a single volume and combine multiple acquisitions by fixed rules. Findings visible in only one plane are thus diluted and of ten missed, lowering recall on clinical efficacy metrics, where a missed abnormality is most costly. We propose GateSPINE, a vision-language framework that fuses sagittal T1 and T2 volumes with a training-free operator, encodes the fused sagittal and axial volumes with two parallel 3D encoders, and decodes their combined representation into a report. Its core mechanism is a gated cross view fusion module that predicts, per feature channel and token, how much of each view to admit, so the more informative view dominates at each spatial location. We evaluate GateSPINE on three lumbar MRI datasets, comprising two public bench marks and a private cohort collected from Phenikaa University Hospital, using both natural language generation (NLG) and clinical efficacy (CE) metrics. GateSPINE achieves the highest CE F1 through improved re call on all three datasets; on SPIDER, which lacks an axial sequence, this reflects the sagittal fusion component rather than the gated cross-view mechanism, which is validated on the two cohorts with both imaging planes. GateSPINE also remains competitive on standard NLG metrics.

Abstract: Cardiac magnetic resonance imaging (CMR) enables assessment of cardiac anatomy, ventricular function, and myocardial tissue characteristics. Clinicians interpret these images by identifying cardiac structures and focusing on the regions relevant to each clinical question, motivating anatomically guided vision-language models (VLMs). Yet CMR-specific supervision for anatomical localisation and clinical question answering remains limited. To address this gap, we investigate fine-grained CMR visual question answering through anatomical grounding and guided attention. We construct 128,915 anatomical-grounding and 42,799 clinical QA pairs across short-axis cine, late gadolinium enhancement, and long-axis cine. These datasets support anatomical recognition, localisation, and clinical assessment without requiring paired reports for individual training images. To help the model learn where to look, we introduce Cardiac Anatomy-Routed Attention (CARA), which selects predicted anatomical priors according to the question and guides decoder attention with learned task-specific strengths. Combining anatomical grounding pretraining with CARA yields our model, CARA-VL. Experiments demonstrate CARA-VL's strengths in clinical assessment and regional localisation across CMR imaging settings, with promising generalization to an external clinical cohort. Together, our data and method provide a practical framework for studying and advancing cardiac visual understanding in VLMs. We will release the QA data derived from public datasets upon publication.

Abstract: Inter-modality MRI translation aims to synthesize missing MRI modalities from available acquisitions, reducing the need for additional scanning while preserving clinically relevant anatomical information. However, existing image translation methods often learn intensity mappings without explicitly separating modality-invariant structural information from modality-specific appearance, which may lead to structural information loss or unrealistic image details. In this work, we propose S2T-Unet, a structure-to-style framework that explicitly models these two aspects. Specifically, vector quantization is introduced at the lower-level bottleneck to encode modality-invariant structural information using a learned discrete codebook. At higher levels, a modality transformation module uses decoder features to condition and transform encoder representations toward the target modality, thereby recovering modality-specific intensity and contrast information. Experiments on the IXI multi-contrast MRI dataset across four translation tasks demonstrate that S2T-Unet is comparable or outperform with state-of-art method.

Abstract: Pretrained 2D foundation models offer a practical alternative to dedicated 3D pretraining for brain structural magnetic resonance imaging (sMRI), but their use on volumetric data requires bridging the mismatch between a 2D encoder and a 3D volume input. Existing methods typically encode slices independently and integrate their features afterwards. We introduce Multiscale Volumetric Reduction (MVR), a reduce-then-encode approach that compresses each anatomical view from (D) slices into (M << D) complementary 2D components before foundation-model encoding. MVR combines an uncentered-PCA base component derived from the original through-plane intensities with residual detail components constructed from multiscale spatial descriptors. The reduction is estimated from the training volumes without diagnostic labels or gradient-based optimization and remains fixed thereafter. The resulting components are independently processed by a shared frozen 2D foundation model and concatenated for linear probing. Under this frozen-encoder setting, MVR achieves strong overall performance across ADNI, OASIS, and ABIDE relative to the evaluated 2D-to-3D adaptation methods and simple input-reduction baselines, while also generalizing strongly from ADNI to AIBL.

Abstract: Recursive self-improvement (RSI) offers a promising path for overcoming the limited visual capability of current medical imaging agents. Yet applying RSI to volumetric imaging remains difficult: failures can arise from acquisition, perception, training recipe, or downstream inference, while self-generated feedback and logged trajectories provide little guidance on which component should change. We introduce ReVision3D, an RSI system that leverages 3D volumes with spatially grounded annotations to determine where visual evidence is lost and recursively improve the corresponding visual capability. A frozen language-model designer proposes revisions to acquisition, perception, training, or inference, while the verifier and system-level objective remain fixed. Our key insight is that an annotated volume forms an exact replay world for view rendering and spatial verification: unvisited views can be rendered on demand, and localized predictions can be checked directly against reference masks. This grounded feedback directs targeted revision, while only changes that improve beyond measured seed noise are retained. Each accepted change triggers renewed attribution, allowing the dominant bottleneck to shift across rounds. On abdominal CT, attribution identifies perception as the dominant remaining limitation. Revising that level enables ReVision3D to achieve 79% liver recall and 83% kidney recall at under 0.4 false positives per patient, outperforming the evaluated frozen multimodal foundation models, with the largest gains on small lesions.

Abstract: Latent generative models make 3D medical image synthesis computationally practical by generating in a compressed space. However, we show that the common flat Euclidean assumption induced by $\ell_2$ objectives is imprecise: latent-space geometry is so strongly anisotropic that equal-magnitude errors can produce drastically different decoded distortions. We further find that this anisotropy has a clear feature: sensitive variation concentrates in a low-rank subspace. The dominant low-rank components capture the overall structure, encoding long-range, spatially coordinated variation while remaining resistant to local noise. Its orthogonal residual, in contrast, mainly captures local and image-specific variation. Motivated by this asymmetry, we introduce Latent Structure Flow (LSF). At each block, LSF decomposes the latent state into structure and residual, models structural changes with global context, and predicts residual variation locally while preserving a direct path for the input structure. LSF changes only the generator, leaving the frozen codec and pointwise training objective unchanged. Across cross-modality synthesis and tumor inpainting tasks, LSF outperforms all compared baselines on both global and tumor-specific metrics, demonstrating the benefit of explicitly modeling latent-space structure for 3D medical image synthesis.

Abstract: Medical report generation has made significant progress with the rise of modern vision-language models and the growing availability of large-scale medical datasets. However, hallucinations remain a major challenge, largely due to the limitations of supervised fine-tuning (SFT), which prioritizes lexical similarity to reference reports rather than clinical correctness. While reinforcement learning has shown strong performance in domains with verifiable rewards such as mathematics and code generation, its application to open-ended medical tasks remains limited. Existing work focuses on evaluating final answers, overlooking the model's reasoning, despite evidence that flawed reasoning can degrade overall performance. In this study, we propose a framework that verifies the model's reasoning process by integrating anatomical regions, bounding boxes, and region-level textual descriptions. We design spatial and factual reward mechanisms to ensure that the model's reasoning is both visually grounded and factually accurate. Starting from Qwen3-VL-8B-Instruct as our base model, we adapt it to the medical domain using supervised fine-tuning, introduce reasoning capability through a cold-start SFT stage, and refine it with reinforcement learning. We find that RL provides performance gains beyond those achievable through SFT alone, and that jointly verifying both reasoning steps and final outputs yields larger improvements than verifying either in isolation. We further identify multiple modes of reward hacking in the RL stage. Finally, the model's structured think traces enhance interpretability, making its outputs easier to audit for clinical use.

Abstract: Vessel segmentation is commonly optimized as voxel-wise classification, but small local errors can strongly disrupt vascular connectivity while having little effect on overlap scores. This is particularly problematic for downstream analyses that rely on centerlines, branches, connected components, or graph structure. We propose a mesh-guided post-processing framework for repairing broken vessel segmentations produced by nnU-Net. For each predicted binary mask, a deformable template mesh is fitted to the mask surface in physical space and used as a case-specific geometric scaffold. The fitted mesh is not voxelized as the final segmentation; instead, it guides conservative reconnection of disconnected components by proposing or validating thin bridge candidates under foreground-growth constraints. We evaluated this approach in three vascular anatomies using AortaSeg24 and SEGA for the aorta, TopCoW for the Circle of Willis, and PARSE for the pulmonary arteries. Performance is measured using Dice, connected-component Dice (ccDice), and the Betti-0 number. Across these datasets, repair substantially improved connectivity while preserving overlap: Dice remained nearly unchanged, whereas ccDice increased from 0.596 to 0.992 for aorta, from 0.722 to 0.835 for TopCoW, and from 0.028 to 0.862 for PARSE. The FOMAML meta-initialization further accelerated the fitting per-case, supporting practical mesh-based repair of the vascular topology. These results suggest that explicit mesh representations can provide a useful geometric prior for correcting topological failures in otherwise accurate voxel segmentations.

Abstract: Bone overlap can obscure abnormalities in chest radiographs, while scarce paired training data limit supervised bone suppression. We address this challenge with a digitally reconstructed radiograph (DRR) framework that converts chest computed tomography (CT) into paired supervision for component suppression. A novel bone segmentation algorithm enables CT decomposition into bone, non-lung soft-tissue, and lung components, which are projected separately. Their weighted combination yields synthetic radiographs with pixel-registered component images that sum exactly to the full DRR. Models trained on these data suppress bone or lung components by predicting the target component and recovering the remainder by subtraction, transferring to real radiographs without real paired training data. As an extension, their outputs on real radiographs provide target domains for unpaired, component-wise DRR translation, reducing the appearance gap while retaining anatomical details. Across multiple public datasets, downstream detection experiments demonstrate the utility of bone suppression, with gains concentrated on abnormalities with substantial bone overlap. Compared with open-source DRR engines applied to the same CTs, our unmodified DRRs achieve comparable realism and preservation of label-relevant anatomy, while translated DRRs achieve the best Fréchet inception distance (FID), lung-field sharpness, and agreement with source-CT anatomy among the evaluated methods. Models and inference code: https://huggingface.co/qureaiorg/bone-suppression; Translated projections: https://huggingface.co/datasets/qureaiorg/ct2xr-projections.

Abstract: Medical image segmenters often get worse when sites, scanner vendors, or protocols change. Continual test-time adaptation (CTTA) addresses this problem without target labels, but it can be impossible to update a model on a non-stationary stream and can lead to a lot of errors. We examine a more reasonable and meaningful alternative: parameter-frozen inference enhancement(PIE). We use a source-trained segmenter that learns about anatomy-preserving scale and flip views, maps their predictions back to the native location, and averages the probabilities. We do not modify the weights of the model or the normalization statistics. On a cardiac MRI stream from M\&Ms, which is trained on vendor A and evaluated sequentially on vendors B, C, and D, PIE has 0.7786 mean Dice, compared to 0.7680 for source-only inference and 0.7388--0.7416 for five other online-adaptation baselines. The controlled ablations show that performance saturates at 28 views, and confidence weighting, class-prior correction, connected-component filtering, morphological refinement, and inter-slice smoothing have no effect or cause negative transfer. Qualitative results on cardiac MRI and fundus images are also consistent with the frozen ensemble keeping thinner and nested anatomical structures. These results provide a strong, stable baseline for medical CTTA and expose an important failure mode: adaptation and handcrafted refinement can be less reliable than carefully designed inference.

Abstract: Magnetic Resonance Imaging (MRI) acquired at different field strengths exhibits pronounced variation in noise, resolution, homogeneity, and contrast, which limits comparability across acquisition settings and complicates downstream analysis. We address this with a unified conditional model for controllable field-to-field synthesis, built on the framework of conditional latent bridge matching. Our single model achieves highly competitive results across the validation phase for all three tasks of the MRIxFields2026 challenge without task-specific architectures or training. We achieve fast generation with only a single inference step, producing all modality and field-strength combinations for $30$ axial slices in under $90$ seconds, as well as cross-modality-strength translation for a full volume in under $70$ seconds, on a single NVIDIA A5000 GPU. We further provide extensive ablations regarding different components of our solution. Code: https://gitlab.com/siddharthsrivastava/mrixfields-2026

Abstract: 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.

Abstract: Medical volume visualization requires selecting regions of interest (ROIs) and carefully controlling their relative visual emphasis according to a given clinical intent. Implementing these decisions in conventional workflows demands substantial clinical and visualization expertise and often involves trial-and-error optimization. Recent agentic systems have introduced natural-language interaction and autonomous visualization operations but largely rely on MLLM-based inference throughout the workflow. Although MLLMs encode broad medical knowledge and provide strong reasoning capabilities, such inference may be suboptimal for medical volume visualization, potentially leading to clinically incomplete interpretations of user requests and unreliable ROI identification and visualization optimization. In this work, we present MedVA, an end-to-end neuro-symbolic agentic system for medical volume visualization that addresses these limitations through three complementary agents. The neuro-symbolic intent formulation agent refines MLLM-based interpretations of natural-language requests through symbolic reasoning over established clinical knowledge, which provides more complete, clinically grounded ROI specifications than MLLM-only reasoning. The multi-model ROI identification agent directly identifies semantically specified ROIs in the original volume by leveraging complementary large-scale pretrained medical segmentation models. The objective-driven visualization optimization agent explicitly evaluates ROI visibility and occlusion in the original volume using a volume-based visibility objective. Extensive agent-level and system-level evaluations across diverse medical datasets and interaction scenarios support the effectiveness of the individual agents. A formative user study further indicates high usability and practical value among users with different levels of expertise.

Abstract: Radiomic texture features are commonly extracted from anisotropic CT and MRI acquisitions, where identical voxel offsets may represent different physical distances. We implemented and validated a voxel-spacing-aware extension of PyRadiomics that incorporates spacing information without generating interpolated gray levels. The framework operates across the Python frontend, C wrapper, and computational backend. GLCM uses anisotropy-relative feature-level angular aggregation, NGTDM uses anisotropy-relative weighted neighborhood averaging, and GLRLM, GLDM, and GLSZM are computed on a finite-volume zero-order-hold representation derived from the native anisotropic grid. Synthetic 3D phantoms were used for software validation. The modified implementation reproduced standard PyRadiomics exactly when spacing-aware mode was disabled and remained equivalent under isotropic spacing across 75 texture features. Under anisotropic spacing, the method selectively modified texture families and was numerically distinct from nearest-neighbor, linear, and B-spline resampling. Computational profiling showed moderate runtime and memory increases, while sensitivity analyses quantified finite-volume rounding effects and confirmed that spacing-aware differences persisted across binWidth settings. The framework provides a backward-compatible technical basis for future evaluation of spacing-aware radiomics in heterogeneous medical imaging datasets.

Abstract: 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.

Abstract: Lung cancer causes more deaths than any other malignancy, and low-dose CT screening is the main pathway to early diagnosis. That pathway hinges on the smallest lesions, yet nodules below six millimeters remain hard to detect, because most methods treat a nodule as a generic object and ignore the imaging physics behind its appearance. We show that this appearance is highly regular. Intensity peaks at the geometric center of a nodule and decays radially in a Gaussian pattern, and a fit to 18,218 annotated lesions from three public benchmarks yields a mean radial coefficient of determination above 0.86 in every dataset and size stratum. A square convolution samples both axes uniformly and is mismatched to this radial signal, most severely for small nodules. Guided by this evidence, we propose GRIPNet (Gaussian Radial Intensity Prior Network), a detector in which every module maps to a measurable property of the intensity distribution. Pinwheel convolutions decompose radial gradients, a dual-frequency module separates boundary detail from structural context, dilated masked attention matches the decay extent, and an adaptive loss reweights samples by conspicuity. GRIPNet raises mAP@0.5 to 95.3, 91.6 and 97.9 percent on KanserSet, LUNA16 and Lung-PET-CT-Dx while sharpening high-IoU localization at real-time speed.

Abstract: Simultaneous assessment of medical imaging and patient records is often required in clinical diagnosis. However, standard machine learning algorithms cannot analyze these data types together. Meanwhile, compliance with HIPAA and GDPR can constrain centralized aggregation of sensitive patient data. This leaves a crucial void of secure fusion of visual and textual context across distant networks. Thus, we present OmniMed-FL, a controlled systems study of multimodal federated learning for five-class clinical condition classification (Normal, Pneumonia, COVID-19, Pleural Effusion, Cardiomegaly). Our proxy corpus pairs 3,000 public chest radiographs with 3,000 class-conditioned synthetic notes, matched by class, not by patient. The framework benchmarks eight fusion strategies, three initializations, four missing-text imputation rules, and matched federated baselines under non-IID Dirichlet partitioning across 3 to 20 hospital clients. As all notes are synthetic and pairing is not patient-level, these are descriptive proxy comparisons, not estimates of diagnostic performance or deployment readiness. Within those limits with clients ($K=5$) and severe skew ($α=0.1$), local-only training achieves a macro-F1 score of 0.297, FedAvg achieves $0.662\pm0.074$, FedProx $0.737\pm0.085$, a matched FedMME-style one-shot ensemble $0.647\pm0.080$, and our SCAFFOLD-AdamW adaptation $0.070\pm0.015$, the 0.075 FedProx-FedAvg gap falling inside the wider of the two two-seed standard deviations. Over a $4\times3$ grid, label skew costs up to 0.27 F1 whereas a near-sevenfold client increase costs at most 0.10, while bidirectional volume grows linearly to 183.5 GiB at $K=20$. Multimodal fusion leads on both corpora, scoring 0.956 against 0.934 for text and 0.664 for images on the synthetic corpus and 0.906 against 0.880 and 0.737 on the radiograph corpus, for $2.3\times$ the model state of text alone.

Abstract: Preoperative evaluation of trigeminal neuralgia (TN) often requires joint interpretation of structural MRI, which depicts the trigeminal nerve and surrounding cisternal anatomy, and time-of-flight MRA, which highlights vascular structures. Although MRI-MRA fusion is clinically attractive for visualizing neurovascular compression, this task is poorly captured by conventional whole-brain registration evaluation because the clinically relevant target is a small trigeminal ROI, vessel annotations are partial and clinically focused, local TOF-MRA contrast is variable, and field-of-view mismatch can limit deformable alignment. We formulate TN MRI-MRA fusion as an ROI-centered neurovascular registration-evaluation problem and construct a benchmark from 149 patients with clinician-annotated bilateral trigeminal ROIs. Six representative registration pipelines were evaluated using local image-based metrics, segmentation-derived vessel-localization metrics, prediction-volume analysis, and contrast- and FOV-stratified comparisons. Conventional evaluation summaries were often misleading: local image similarity, vessel-background separability, and downstream vessel localization did not co-rank methods; one-sided vessel distances were strongly affected by predicted vessel extent under partial annotations; and local MRA contrast determined when vessel-separability metrics were informative. Deformable refinement provided only a small, FOV-dependent benefit over affine alignment, while reader review showed that locally favorable vessel distances could coexist with globally implausible registrations. These findings indicate that TN MRI-MRA registration should be evaluated as a local, vessel-aware, contrast-sensitive, and FOV-aware visualization task rather than as generic multimodal brain registration. Our code is publicly available at https://github.com/jhuldr/TN-Reg-Benchmark.

Abstract: 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

Abstract: 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.

Abstract: Deep learning models for CT scan analysis are often limited by the scarcity of precise pixel-level annotations, which require significant radiologist effort to produce. Training on scan-level labels alone reduces annotation requirements but introduces challenges: low supervision ratios and large input volumes make models prone to overfitting and shortcut learning. In this work, we investigate two complementary methods to address these challenges: multi-instance learning (MIL) and anatomical filtering. MIL divides CT volumes into 2D slice instances, enabling efficient 2D architectures with ImageNet pretraining rather than computationally demanding 3D models. Anatomical filtering uses Compass, our self-supervised body part regression model, to crop scans to pathology-relevant subregions without requiring segmentation masks. We evaluate two MIL frameworks - Attention-based MIL (ABMIL) and FocusMIL - on kidney tumor classification across one internal dataset (TUH) and two external datasets (KiTS23 and TCGA-KiRC). Our best models achieve F1 = 0.83 on the internal test set using only scan-level labels. We further show that anatomical filtering with the Compass model is critical for the out-of-distribution generalization of embedding-based ABMIL, while instance-based FocusMIL demonstrates greater inherent robustness to distribution shift. While evaluated on kidney tumors, we consider this a proof-of-concept for a broader weakly supervised CT classification pipeline applicable to other organs and pathologies.

Abstract: Accurate segmentation of pulmonary lesions is essential for effective clinical diagnosis and treatment strategies. Existing segmentation approaches often lack task-specific semantic guidance, as text-based annotations typically offer coarse localization of lesions, leading to inadequate delineation of lesion boundaries and poor performance on small-scale lesions. To address this, we propose CGSM, a Concept-Guided Segmentation Model that integrates LLM-generated and clinically reviewed concepts into the segmentation process. Specifically, we design a Concept-Visual Alignment Module (CVAM) to activate relevant tokens within the concepts that align with visual features, enhancing the interaction between textual and visual information. In addition, we introduce a Concept Modulated Decoder (CM-Decoder), which uses concepts from CVAM as modulation signals to facilitate the adaptive fusion of image and text features, improving the segmentation accuracy. Extensive experiments on two public datasets show that CGSM achieves state-of-the-art performance, with results of 91.59% Dice and 84.49% mIoU on the QaTa-COV19 dataset, demonstrating its effectiveness in pulmonary lesion segmentation.