radiology workflow managers

Abstract: Vision-language models (VLMs) achieve remarkable performance on 2D medical images, such as X-rays or pathology images, while 3D VLMs that directly process CT/MRI volumes lag behind due to limited 3D training data and the predominance of 2D foundation architectures. To leverage powerful 2D VLMs for analyzing medical volumes, which contain hundreds of slices, it is therefore necessary to focus only on those few slices, which are diagnostically relevant. To enable such a prioritization, we propose XGLASS, a method that transfers medical expertise from 2D X-rays to 3D CT for task-aware slice prioritization. XGLASS uses disease-conditioned importance maps derived from language-aligned radiologist gaze on X-rays and spatially aligns them with coronal CT projections, bringing gaze priors and CT content into a shared 2D representation. The fused gaze-prior/CT projection is then used to predict a disease-specific ordering of axial slices, prioritizing diagnostically relevant slices. XGLASS significantly improves budgeted retrieval over 2D and 3D-native baselines, achieving a top-10 hit rate up to 75.9% for the best-performing disease. In practice, this means that after inspecting only the top 10 slices (4.17% of a 240-slice scan), XGLASS identifies a diagnostically relevant slice in more than 75% of cases. For downstream slice-wise finding classification, an XGLASS-selected 30-slice candidate set reduces model calls by 87.5% while improving F1 by 11.3 percentage points over all-slice inference, 4.2 points over the strongest 2D selector, and remains competitive with 3D-native selectors while requiring up to 130.8 times less time and 10.9 times less GPU memory per finding, supporting its use as a lightweight preselector for volumetric CT analysis. The code and pretrained checkpoint are available on https://github.com/michaelgloeckler/XGLASS.

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

Abstract: Multimodal image registration is a key component of many clinical workflows, yet it remains challenging because corresponding anatomical structures often exhibit substantially different image intensities across modalities. In this work, we present a comprehensive benchmark of intra-patient 3D multimodal deformable registration methods across three datasets covering different anatomical regions and difficulty levels, including both synthetic deformation recovery and real clinical scenarios. We evaluate classical optimization-based approaches and modern learning-based methods, including recent deep learning and foundation models, using complementary metrics: Average Dice similarity coefficient (DSC), average 95th-percentile Hausdorff distance (HD95), and a modality-independent structural similarity measure based on the MIND self-similarity context (MIND-SSC). Results show high variability across datasets, with learning-based methods demonstrating superior performance on large synthetic benchmarks, while only limited improvements are observed in real pelvic registration. A key finding of this study is the consistent disagreement between geometric metrics (DSC, HD95) and image-based similarity metrics (MIND-SSC), highlighting that improved overlap does not necessarily imply better global multimodal correspondence. Furthermore, anatomy-guided approaches achieve the highest overlap scores but exhibit degraded performance outside of segmented regions, revealing a trade-off between label-driven alignment and global structural coherence. Overall, our results indicate that no current method achieves robust performance across anatomies and modalities. We demonstrate that intra-patient 3D multimodal registration requires multi-criteria evaluation, including deformation-based metrics, and remains an open problem.