Foundation models, pre-trained on large image datasets and capable of capturing rich feature representations, have recently shown potential for zero-shot image registration. However, their performance has mostly been tested in the context of rigid or less complex structures, such as the brain or abdominal organs, and it remains unclear whether these models can handle more challenging, deformable anatomy. Breast MRI registration is particularly difficult due to significant anatomical variation between patients, deformation caused by patient positioning, and the presence of thin and complex internal structure of fibroglandular tissue, where accurate alignment is crucial. Whether foundation model-based registration algorithms can address this level of complexity remains an open question. In this study, we provide a comprehensive evaluation of foundation model-based registration algorithms for breast MRI. We assess five pre-trained encoders, including DINO-v2, SAM, MedSAM, SSLSAM, and MedCLIP, across four key breast registration tasks that capture variations in different years and dates, sequences, modalities, and patient disease status (lesion versus no lesion). Our results show that foundation model-based algorithms such as SAM outperform traditional registration baselines for overall breast alignment, especially under large domain shifts, but struggle with capturing fine details of fibroglandular tissue. Interestingly, additional pre-training or fine-tuning on medical or breast-specific images in MedSAM and SSLSAM, does not improve registration performance and may even decrease it in some cases. Further work is needed to understand how domain-specific training influences registration and to explore targeted strategies that improve both global alignment and fine structure accuracy. We also publicly release our code at \href{https://github.com/mazurowski-lab/Foundation-based-reg}{Github}.
Pediatric medical imaging presents unique challenges due to significant anatomical and developmental differences compared to adults. Direct application of segmentation models trained on adult data often yields suboptimal performance, particularly for small or rapidly evolving structures. To address these challenges, several strategies leveraging the nnU-Net framework have been proposed, differing along four key axes: (i) the fingerprint dataset (adult, pediatric, or a combination thereof) from which the Training Plan -including the network architecture-is derived; (ii) the Learning Set (adult, pediatric, or mixed), (iii) Data Augmentation parameters, and (iv) the Transfer learning method (finetuning versus continual learning). In this work, we introduce PSAT (Pediatric Segmentation Approaches via Adult Augmentations and Transfer learning), a systematic study that investigates the impact of these axes on segmentation performance. We benchmark the derived strategies on two pediatric CT datasets and compare them with state-of-theart methods, including a commercial radiotherapy solution. PSAT highlights key pitfalls and provides actionable insights for improving pediatric segmentation. Our experiments reveal that a training plan based on an adult fingerprint dataset is misaligned with pediatric anatomy-resulting in significant performance degradation, especially when segmenting fine structures-and that continual learning strategies mitigate institutional shifts, thus enhancing generalization across diverse pediatric datasets. The code is available at https://github.com/ICANS-Strasbourg/PSAT.
X-ray imaging is a rapid and cost-effective tool for visualizing internal human anatomy. While multi-view X-ray imaging provides complementary information that enhances diagnosis, intervention, and education, acquiring images from multiple angles increases radiation exposure and complicates clinical workflows. To address these challenges, we propose a novel view-conditioned diffusion model for synthesizing multi-view X-ray images from a single view. Unlike prior methods, which are limited in angular range, resolution, and image quality, our approach leverages the Diffusion Transformer to preserve fine details and employs a weak-to-strong training strategy for stable high-resolution image generation. Experimental results demonstrate that our method generates higher-resolution outputs with improved control over viewing angles. This capability has significant implications not only for clinical applications but also for medical education and data extension, enabling the creation of diverse, high-quality datasets for training and analysis. Our code is available at GitHub.
In augmented reality (AR)-guided surgical navigation, preoperative organ models are superimposed onto the patient's intraoperative anatomy to visualize critical structures such as vessels and tumors. Accurate deformation modeling is essential to maintain the reliability of AR overlays by ensuring alignment between preoperative models and the dynamically changing anatomy. Although the finite element method (FEM) offers physically plausible modeling, its high computational cost limits intraoperative applicability. Moreover, existing algorithms often fail to handle large anatomical changes, such as those induced by pneumoperitoneum or ligament dissection, leading to inaccurate anatomical correspondences and compromised AR guidance. To address these challenges, we propose a data-driven biomechanics algorithm that preserves FEM-level accuracy while improving computational efficiency. In addition, we introduce a novel human-in-the-loop mechanism into the deformation modeling process. This enables surgeons to interactively provide prompts to correct anatomical misalignments, thereby incorporating clinical expertise and allowing the model to adapt dynamically to complex surgical scenarios. Experiments on a publicly available dataset demonstrate that our algorithm achieves a mean target registration error of 3.42 mm. Incorporating surgeon prompts through the interactive framework further reduces the error to 2.78 mm, surpassing state-of-the-art methods in volumetric accuracy. These results highlight the ability of our framework to deliver efficient and accurate deformation modeling while enhancing surgeon-algorithm collaboration, paving the way for safer and more reliable computer-assisted surgeries.
Intraventricular hemorrhage (IVH) is a severe neurological complication among premature infants, necessitating early and accurate detection from brain ultrasound (US) images to improve clinical outcomes. While recent deep learning methods offer promise for computer-aided diagnosis, challenges remain in capturing both local spatial details and global contextual dependencies critical for segmenting brain anatomies. In this work, we propose an enhanced Residual U-Net architecture incorporating two complementary attention mechanisms: the Convolutional Block Attention Module (CBAM) and a Sparse Attention Layer (SAL). The CBAM improves the model's ability to refine spatial and channel-wise features, while the SAL introduces a dual-branch design, sparse attention filters out low-confidence query-key pairs to suppress noise, and dense attention ensures comprehensive information propagation. Extensive experiments on the Brain US dataset demonstrate that our method achieves state-of-the-art segmentation performance, with a Dice score of 89.04% and IoU of 81.84% for ventricle region segmentation. These results highlight the effectiveness of integrating spatial refinement and attention sparsity for robust brain anatomy detection. Code is available at: https://github.com/DanYuan001/BrainImgSegment.
Vision-Language Models (VLMs) have shown promise in various 2D visual tasks, yet their readiness for 3D clinical diagnosis remains unclear due to stringent demands for recognition precision, reasoning ability, and domain knowledge. To systematically evaluate these dimensions, we present DeepTumorVQA, a diagnostic visual question answering (VQA) benchmark targeting abdominal tumors in CT scans. It comprises 9,262 CT volumes (3.7M slices) from 17 public datasets, with 395K expert-level questions spanning four categories: Recognition, Measurement, Visual Reasoning, and Medical Reasoning. DeepTumorVQA introduces unique challenges, including small tumor detection and clinical reasoning across 3D anatomy. Benchmarking four advanced VLMs (RadFM, M3D, Merlin, CT-CHAT), we find current models perform adequately on measurement tasks but struggle with lesion recognition and reasoning, and are still not meeting clinical needs. Two key insights emerge: (1) large-scale multimodal pretraining plays a crucial role in DeepTumorVQA testing performance, making RadFM stand out among all VLMs. (2) Our dataset exposes critical differences in VLM components, where proper image preprocessing and design of vision modules significantly affect 3D perception. To facilitate medical multimodal research, we have released DeepTumorVQA as a rigorous benchmark: https://github.com/Schuture/DeepTumorVQA.
Determining the 3D pose of a patient from a limited set of 2D X-ray images is a critical task in interventional settings. While preoperative volumetric imaging (e.g., CT and MRI) provides precise 3D localization and visualization of anatomical targets, these modalities cannot be acquired during procedures, where fast 2D imaging (X-ray) is used instead. To integrate volumetric guidance into intraoperative procedures, we present PolyPose, a simple and robust method for deformable 2D/3D registration. PolyPose parameterizes complex 3D deformation fields as a composition of rigid transforms, leveraging the biological constraint that individual bones do not bend in typical motion. Unlike existing methods that either assume no inter-joint movement or fail outright in this under-determined setting, our polyrigid formulation enforces anatomically plausible priors that respect the piecewise rigid nature of human movement. This approach eliminates the need for expensive deformation regularizers that require patient- and procedure-specific hyperparameter optimization. Across extensive experiments on diverse datasets from orthopedic surgery and radiotherapy, we show that this strong inductive bias enables PolyPose to successfully align the patient's preoperative volume to as few as two X-ray images, thereby providing crucial 3D guidance in challenging sparse-view and limited-angle settings where current registration methods fail.
Reliable MRI defacing techniques to safeguard patient privacy while preserving brain anatomy are critical for research collaboration. Existing methods often struggle with incomplete defacing or degradation of brain tissue regions. We present a robust, generalisable defacing pipeline for high-resolution MRI that integrates atlas-based registration with brain masking. Our method was evaluated on 2,566 heterogeneous clinical scans for meningioma and achieved a 99.92 per cent success rate (2,564/2,566) upon visual inspection. Excellent anatomical preservation is demonstrated with a Dice similarity coefficient of 0.9975 plus or minus 0.0023 between brain masks automatically extracted from the original and defaced volumes. Source code is available at https://github.com/cai4cai/defacing_pipeline.
High-quality 3D reconstruction of pulmonary segments plays a crucial role in segmentectomy and surgical treatment planning for lung cancer. Due to the resolution requirement of the target reconstruction, conventional deep learning-based methods often suffer from computational resource constraints or limited granularity. Conversely, implicit modeling is favored due to its computational efficiency and continuous representation at any resolution. We propose a neural implicit function-based method to learn a 3D surface to achieve anatomy-aware, precise pulmonary segment reconstruction, represented as a shape by deforming a learnable template. Additionally, we introduce two clinically relevant evaluation metrics to assess the reconstruction comprehensively. Further, due to the absence of publicly available shape datasets to benchmark reconstruction algorithms, we developed a shape dataset named Lung3D, including the 3D models of 800 labeled pulmonary segments and the corresponding airways, arteries, veins, and intersegmental veins. We demonstrate that the proposed approach outperforms existing methods, providing a new perspective for pulmonary segment reconstruction. Code and data will be available at https://github.com/M3DV/ImPulSe.
Accurate kinetic analysis of [$^{18}$F]FDG distribution in dynamic positron emission tomography (PET) requires anatomically constrained modelling of image-derived input functions (IDIFs). Traditionally, IDIFs are obtained from the aorta, neglecting anatomical variations and complex vascular contributions. This study proposes a multi-organ segmentation-based approach that integrates IDIFs from the aorta, portal vein, pulmonary artery, and ureters. Using high-resolution CT segmentations of the liver, lungs, kidneys, and bladder, we incorporate organ-specific blood supply sources to improve kinetic modelling. Our method was evaluated on dynamic [$^{18}$F]FDG PET data from nine patients, resulting in a mean squared error (MSE) reduction of $13.39\%$ for the liver and $10.42\%$ for the lungs. These initial results highlight the potential of multiple IDIFs in improving anatomical modelling and fully leveraging dynamic PET imaging. This approach could facilitate the integration of tracer kinetic modelling into clinical routine.
Deep learning-based point cloud modeling has been widely investigated as an indispensable component of general shape analysis. Recently, transformer and state space model (SSM) have shown promising capacities in point cloud learning. However, limited research has been conducted on medical point clouds, which have great potential in disease diagnosis and treatment. This paper presents an SSM-based hierarchical feature learning framework for medical point cloud understanding. Specifically, we down-sample input into multiple levels through the farthest point sampling. At each level, we perform a series of k-nearest neighbor (KNN) queries to aggregate multi-scale structural information. To assist SSM in processing point clouds, we introduce coordinate-order and inside-out scanning strategies for efficient serialization of irregular points. Point features are calculated progressively from short neighbor sequences and long point sequences through vanilla and group Point SSM blocks, to capture both local patterns and long-range dependencies. To evaluate the proposed method, we build a large-scale medical point cloud dataset named MedPointS for anatomy classification, completion, and segmentation. Extensive experiments conducted on MedPointS demonstrate that our method achieves superior performance across all tasks. The dataset is available at https://flemme-docs.readthedocs.io/en/latest/medpoints.html. Code is merged to a public medical imaging platform: https://github.com/wlsdzyzl/flemme.
Cardiac magnetic resonance imaging is the gold standard for non-invasive cardiac assessment, offering rich spatio-temporal views of the cardiac anatomy and physiology. Patient-level health factors, such as demographics, metabolic, and lifestyle, are known to substantially influence cardiovascular health and disease risk, yet remain uncaptured by CMR alone. To holistically understand cardiac health and to enable the best possible interpretation of an individual's disease risk, CMR and patient-level factors must be jointly exploited within an integrated framework. Recent multi-modal approaches have begun to bridge this gap, yet they often rely on limited spatio-temporal data and focus on isolated clinical tasks, thereby hindering the development of a comprehensive representation for cardiac health evaluation. To overcome these limitations, we introduce ViTa, a step toward foundation models that delivers a comprehensive representation of the heart and a precise interpretation of individual disease risk. Leveraging data from 42,000 UK Biobank participants, ViTa integrates 3D+T cine stacks from short-axis and long-axis views, enabling a complete capture of the cardiac cycle. These imaging data are then fused with detailed tabular patient-level factors, enabling context-aware insights. This multi-modal paradigm supports a wide spectrum of downstream tasks, including cardiac phenotype and physiological feature prediction, segmentation, and classification of cardiac and metabolic diseases within a single unified framework. By learning a shared latent representation that bridges rich imaging features and patient context, ViTa moves beyond traditional, task-specific models toward a universal, patient-specific understanding of cardiac health, highlighting its potential to advance clinical utility and scalability in cardiac analysis.
X-ray imaging plays a crucial role in the medical field, providing essential insights into the internal anatomy of patients for diagnostics, image-guided procedures, and clinical decision-making. Traditional techniques often require multiple X-ray projections from various angles to obtain a comprehensive view, leading to increased radiation exposure and more complex clinical processes. This paper explores an innovative approach using the DL-GIPS model, which synthesizes X-ray projections from new viewpoints by leveraging a single existing projection. The model strategically manipulates geometry and texture features extracted from an initial projection to match new viewing angles. It then synthesizes the final projection by merging these modified geometry features with consistent texture information through an advanced image generation process. We demonstrate the effectiveness and broad applicability of the DL-GIPS framework through lung imaging examples, highlighting its potential to revolutionize stereoscopic and volumetric imaging by minimizing the need for extensive data acquisition.
Echocardiography is crucial for cardiovascular disease detection but relies heavily on experienced sonographers. Echocardiography probe guidance systems, which provide real-time movement instructions for acquiring standard plane images, offer a promising solution for AI-assisted or fully autonomous scanning. However, developing effective machine learning models for this task remains challenging, as they must grasp heart anatomy and the intricate interplay between probe motion and visual signals. To address this, we present EchoWorld, a motion-aware world modeling framework for probe guidance that encodes anatomical knowledge and motion-induced visual dynamics, while effectively leveraging past visual-motion sequences to enhance guidance precision. EchoWorld employs a pre-training strategy inspired by world modeling principles, where the model predicts masked anatomical regions and simulates the visual outcomes of probe adjustments. Built upon this pre-trained model, we introduce a motion-aware attention mechanism in the fine-tuning stage that effectively integrates historical visual-motion data, enabling precise and adaptive probe guidance. Trained on more than one million ultrasound images from over 200 routine scans, EchoWorld effectively captures key echocardiographic knowledge, as validated by qualitative analysis. Moreover, our method significantly reduces guidance errors compared to existing visual backbones and guidance frameworks, excelling in both single-frame and sequential evaluation protocols. Code is available at https://github.com/LeapLabTHU/EchoWorld.
Current self-supervised methods, such as contrastive learning, predominantly focus on global discrimination, neglecting the critical fine-grained anatomical details required for accurate radiographic analysis. To address this challenge, we propose an Anatomy-driven self-supervised framework for enhancing Fine-grained Representation in radiographic image analysis (AFiRe). The core idea of AFiRe is to align the anatomical consistency with the unique token-processing characteristics of Vision Transformer. Specifically, AFiRe synergistically performs two self-supervised schemes: (i) Token-wise anatomy-guided contrastive learning, which aligns image tokens based on structural and categorical consistency, thereby enhancing fine-grained spatial-anatomical discrimination; (ii) Pixel-level anomaly-removal restoration, which particularly focuses on local anomalies, thereby refining the learned discrimination with detailed geometrical information. Additionally, we propose Synthetic Lesion Mask to enhance anatomical diversity while preserving intra-consistency, which is typically corrupted by traditional data augmentations, such as Cropping and Affine transformations. Experimental results show that AFiRe: (i) provides robust anatomical discrimination, achieving more cohesive feature clusters compared to state-of-the-art contrastive learning methods; (ii) demonstrates superior generalization, surpassing 7 radiography-specific self-supervised methods in multi-label classification tasks with limited labeling; and (iii) integrates fine-grained information, enabling precise anomaly detection using only image-level annotations.
The automatic generation of brain CT reports has gained widespread attention, given its potential to assist radiologists in diagnosing cranial diseases. However, brain CT scans involve extensive medical entities, such as diverse anatomy regions and lesions, exhibiting highly inconsistent spatial patterns in 3D volumetric space. This leads to biased learning of medical entities in existing methods, resulting in repetitiveness and inaccuracy in generated reports. To this end, we propose a Medical Entity-balanced Prompting Network (MEPNet), which harnesses the large language model (LLM) to fairly interpret various entities for accurate brain CT report generation. By introducing the visual embedding and the learning status of medical entities as enriched clues, our method prompts the LLM to balance the learning of diverse entities, thereby enhancing reports with comprehensive findings. First, to extract visual embedding of entities, we propose Knowledge-driven Joint Attention to explore and distill entity patterns using both explicit and implicit medical knowledge. Then, a Learning Status Scorer is designed to evaluate the learning of entity visual embeddings, resulting in unique learning status for individual entities. Finally, these entity visual embeddings and status are elaborately integrated into multi-modal prompts, to guide the text generation of LLM. This process allows LLM to self-adapt the learning process for biased-fitted entities, thereby covering detailed findings in generated reports. We conduct experiments on two brain CT report generation benchmarks, showing the effectiveness in clinical accuracy and text coherence.
Extracting structured labels from radiology reports has been employed to create vision models to simultaneously detect several types of abnormalities. However, existing works focus mainly on the chest region. Few works have been investigated on abdominal radiology reports due to more complex anatomy and a wider range of pathologies in the abdomen. We propose LEAVS (Large language model Extractor for Abdominal Vision Supervision). This labeler can annotate the certainty of presence and the urgency of seven types of abnormalities for nine abdominal organs on CT radiology reports. To ensure broad coverage, we chose abnormalities that encompass most of the finding types from CT reports. Our approach employs a specialized chain-of-thought prompting strategy for a locally-run LLM using sentence extraction and multiple-choice questions in a tree-based decision system. We demonstrate that the LLM can extract several abnormality types across abdominal organs with an average F1 score of 0.89, significantly outperforming competing labelers and humans. Additionally, we show that extraction of urgency labels achieved performance comparable to human annotations. Finally, we demonstrate that the abnormality labels contain valuable information for training a single vision model that classifies several organs as normal or abnormal. We release our code and structured annotations for a public CT dataset containing over 1,000 CT volumes.
Serialized TV shows are built on complex storylines that can be hard to track and evolve in ways that defy straightforward analysis. This paper introduces a multi-agent system designed to extract and analyze these narrative arcs. Tested on the first season of Grey's Anatomy (ABC 2005-), the system identifies three types of arcs: Anthology (self-contained), Soap (relationship-focused), and Genre-Specific (strictly related to the series' genre). Episodic progressions of these arcs are stored in both relational and semantic (vectorial) databases, enabling structured analysis and comparison. To bridge the gap between automation and critical interpretation, the system is paired with a graphical interface that allows for human refinement using tools to enhance and visualize the data. The system performed strongly in identifying Anthology Arcs and character entities, but its reliance on textual paratexts (such as episode summaries) revealed limitations in recognizing overlapping arcs and subtler dynamics. This approach highlights the potential of combining computational and human expertise in narrative analysis. Beyond television, it offers promise for serialized written formats, where the narrative resides entirely in the text. Future work will explore the integration of multimodal inputs, such as dialogue and visuals, and expand testing across a wider range of genres to refine the system further.
Cervical spondylosis, a complex and prevalent condition, demands precise and efficient diagnostic techniques for accurate assessment. While MRI offers detailed visualization of cervical spine anatomy, manual interpretation remains labor-intensive and prone to error. To address this, we developed an innovative AI-assisted Expert-based Diagnosis System that automates both segmentation and diagnosis of cervical spondylosis using MRI. Leveraging a dataset of 960 cervical MRI images from patients with cervical disc herniation, our system features a pathology-guided segmentation model capable of accurately segmenting key cervical anatomical structures. The segmentation is followed by an expert-based diagnostic framework that automates the calculation of critical clinical indicators. Our segmentation model achieved an impressive average Dice coefficient exceeding 0.90 across four cervical spinal anatomies and demonstrated enhanced accuracy in herniation areas. Diagnostic evaluation further showcased the system precision, with a mean absolute error (MAE) of 2.44 degree for the C2-C7 Cobb angle and 3.60 precentage for the Maximum Spinal Cord Compression (MSCC) coefficient. In addition, our method delivered high accuracy, precision, recall, and F1 scores in herniation localization, K-line status assessment, and T2 hyperintensity detection. Comparative analysis demonstrates that our system outperforms existing methods, establishing a new benchmark for segmentation and diagnostic tasks for cervical spondylosis.
Reducing radiation doses benefits patients, however, the resultant low-dose computed tomography (LDCT) images often suffer from clinically unacceptable noise and artifacts. While deep learning (DL) shows promise in LDCT reconstruction, it requires large-scale data collection from multiple clients, raising privacy concerns. Federated learning (FL) has been introduced to address these privacy concerns; however, current methods are typically tailored to specific scanning protocols, which limits their generalizability and makes them less effective for unseen protocols. To address these issues, we propose SCAN-PhysFed, a novel SCanning- and ANatomy-level personalized Physics-Driven Federated learning paradigm for LDCT reconstruction. Since the noise distribution in LDCT data is closely tied to scanning protocols and anatomical structures being scanned, we design a dual-level physics-informed way to address these challenges. Specifically, we incorporate physical and anatomical prompts into our physics-informed hypernetworks to capture scanning- and anatomy-specific information, enabling dual-level physics-driven personalization of imaging features. These prompts are derived from the scanning protocol and the radiology report generated by a medical large language model (MLLM), respectively. Subsequently, client-specific decoders project these dual-level personalized imaging features back into the image domain. Besides, to tackle the challenge of unseen data, we introduce a novel protocol vector-quantization strategy (PVQS), which ensures consistent performance across new clients by quantifying the unseen scanning code as one of the codes in the scanning codebook. Extensive experimental results demonstrate the superior performance of SCAN-PhysFed on public datasets.