Robust XAI techniques should ideally be simultaneously deterministic, model agnostic, and guaranteed to converge. We propose MULTIDIMENSIONAL PROBLEM AGNOSTIC EXPLAINABLE AI (MUPAX), a deterministic, model agnostic explainability technique, with guaranteed convergency. MUPAX measure theoretic formulation gives principled feature importance attribution through structured perturbation analysis that discovers inherent input patterns and eliminates spurious relationships. We evaluate MUPAX on an extensive range of data modalities and tasks: audio classification (1D), image classification (2D), volumetric medical image analysis (3D), and anatomical landmark detection, demonstrating dimension agnostic effectiveness. The rigorous convergence guarantees extend to any loss function and arbitrary dimensions, making MUPAX applicable to virtually any problem context for AI. By contrast with other XAI methods that typically decrease performance when masking, MUPAX not only preserves but actually enhances model accuracy by capturing only the most important patterns of the original data. Extensive benchmarking against the state of the XAI art demonstrates MUPAX ability to generate precise, consistent and understandable explanations, a crucial step towards explainable and trustworthy AI systems. The source code will be released upon publication.
Recent advancements in medical image analysis have led to the development of highly specialized models tailored to specific clinical tasks. These models have demonstrated exceptional performance and remain a crucial research direction. Yet, their applicability is limited to predefined tasks, requiring expertise and extensive resources for development and adaptation. In contrast, generalist models offer a different form of utility: allowing medical practitioners to define tasks on the fly without the need for task-specific model development. In this work, we explore how to train generalist models for the domain of retinal optical coherence tomography using visual in-context learning (VICL), i.e., training models to generalize across tasks based on a few examples provided at inference time. To facilitate rigorous assessment, we propose a broad evaluation protocol tailored to VICL in OCT. We extensively evaluate a state-of-the-art medical VICL approach on multiple retinal OCT datasets, establishing a first baseline to highlight the potential and current limitations of in-context learning for OCT. To foster further research and practical adoption, we openly release our code.
Current medical image analysis systems are typically task-specific, requiring separate models for classification and segmentation, and lack the flexibility to support user-defined workflows. To address these challenges, we introduce MedPrompt, a unified framework that combines a few-shot prompted Large Language Model (Llama-4-17B) for high-level task planning with a modular Convolutional Neural Network (DeepFusionLab) for low-level image processing. The LLM interprets user instructions and generates structured output to dynamically route task-specific pretrained weights. This weight routing approach avoids retraining the entire framework when adding new tasks-only task-specific weights are required, enhancing scalability and deployment. We evaluated MedPrompt across 19 public datasets, covering 12 tasks spanning 5 imaging modalities. The system achieves a 97% end-to-end correctness in interpreting and executing prompt-driven instructions, with an average inference latency of 2.5 seconds, making it suitable for near real-time applications. DeepFusionLab achieves competitive segmentation accuracy (e.g., Dice 0.9856 on lungs) and strong classification performance (F1 0.9744 on tuberculosis). Overall, MedPrompt enables scalable, prompt-driven medical imaging by combining the interpretability of LLMs with the efficiency of modular CNNs.
Image registration is used in many medical image analysis applications, such as tracking the motion of tissue in cardiac images, where cardiac kinematics can be an indicator of tissue health. Registration is a challenging problem for deep learning algorithms because ground truth transformations are not feasible to create, and because there are potentially multiple transformations that can produce images that appear correlated with the goal. Unsupervised methods have been proposed to learn to predict effective transformations, but these methods take significantly longer to predict than established baseline methods. For a deep learning method to see adoption in wider research and clinical settings, it should be designed to run in a reasonable time on common, mid-level hardware. Fast methods have been proposed for the task of image registration but often use patch-based methods which can affect registration accuracy for a highly dynamic organ such as the heart. In this thesis, a fast, volumetric registration model is proposed for the use of quantifying cardiac strain. The proposed Deep Learning Neural Network (DLNN) is designed to utilize an architecture that can compute convolutions incredibly efficiently, allowing the model to achieve registration fidelity similar to other state-of-the-art models while taking a fraction of the time to perform inference. The proposed fast and lightweight registration (FLIR) model is used to predict tissue motion which is then used to quantify the non-uniform strain experienced by the tissue. For acquisitions taken from the same patient at approximately the same time, it would be expected that strain values measured between the acquisitions would have very small differences. Using this metric, strain values computed using the FLIR method are shown to be very consistent.
Modern Vision-Language Models (VLMs) exhibit unprecedented capabilities in cross-modal semantic understanding between visual and textual modalities. Given the intrinsic need for multi-modal integration in clinical applications, VLMs have emerged as a promising solution for a wide range of medical image analysis tasks. However, adapting general-purpose VLMs to medical domain poses numerous challenges, such as large domain gaps, complicated pathological variations, and diversity and uniqueness of different tasks. The central purpose of this review is to systematically summarize recent advances in adapting VLMs for medical image analysis, analyzing current challenges, and recommending promising yet urgent directions for further investigations. We begin by introducing core learning strategies for medical VLMs, including pretraining, fine-tuning, and prompt learning. We then categorize five major VLM adaptation strategies for medical image analysis. These strategies are further analyzed across eleven medical imaging tasks to illustrate their current practical implementations. Furthermore, we analyze key challenges that impede the effective adaptation of VLMs to clinical applications and discuss potential directions for future research. We also provide an open-access repository of related literature to facilitate further research, available at https://github.com/haonenglin/Awesome-VLM-for-MIA. It is anticipated that this article can help researchers who are interested in harnessing VLMs in medical image analysis tasks have a better understanding on their capabilities and limitations, as well as current technical barriers, to promote their innovative, robust, and safe application in clinical practice.
Medical image analysis increasingly relies on the integration of multiple imaging modalities to capture complementary anatomical and functional information, enabling more accurate diagnosis and treatment planning. Achieving aligned feature representations across these diverse modalities is therefore important for effective multimodal analysis. While contrastive language-image pre-training (CLIP) and its variant have enabled image-text alignments, they require explicitly paired data between arbitrary two modalities, which is difficult to acquire in medical contexts. To address the gap, we present Multimodal Medical Image Binding with Text (M\textsuperscript{3}Bind), a novel pre-training framework that enables seamless alignment of multiple medical imaging modalities through a shared text representation space without requiring explicit paired data between any two medical image modalities. Specifically, based on the insight that different images can naturally bind with text, M\textsuperscript{3}Bind first fine-tunes pre-trained CLIP-like image-text models to align their modality-specific text embedding space while preserving their original image-text alignments. Subsequently, we distill these modality-specific text encoders into a unified model, creating a shared text embedding space. Experiments on X-ray, CT, retina, ECG, and pathological images on multiple downstream tasks demonstrate that M\textsuperscript{3}Bind achieves state-of-the-art performance in zero-shot, few-shot classification and cross-modal retrieval tasks compared to its CLIP-like counterparts. These results validate M\textsuperscript{3}Bind's effectiveness in achieving cross-image-modal alignment for medical analysis.
Federated learning (FL) has emerged as a promising approach for collaborative medical image analysis, enabling multiple institutions to build robust predictive models while preserving sensitive patient data. In the context of Whole Slide Image (WSI) classification, FL faces significant challenges, including heterogeneous computational resources across participating medical institutes and privacy concerns. To address these challenges, we propose FedWSIDD, a novel FL paradigm that leverages dataset distillation (DD) to learn and transmit synthetic slides. On the server side, FedWSIDD aggregates synthetic slides from participating centres and distributes them across all centres. On the client side, we introduce a novel DD algorithm tailored to histopathology datasets which incorporates stain normalisation into the distillation process to generate a compact set of highly informative synthetic slides. These synthetic slides, rather than model parameters, are transmitted to the server. After communication, the received synthetic slides are combined with original slides for local tasks. Extensive experiments on multiple WSI classification tasks, including CAMELYON16 and CAMELYON17, demonstrate that FedWSIDD offers flexibility for heterogeneous local models, enhances local WSI classification performance, and preserves patient privacy. This makes it a highly effective solution for complex WSI classification tasks. The code is available at FedWSIDD.
This paper presents a lightweight framework for classifying brain stroke types from Diffusion-Weighted Imaging (DWI) MRI scans, employing a Multi-Layer Perceptron (MLP) neural network with Wavelet Transform for feature extraction. Accurate and timely stroke detection is critical for effective treatment and improved patient outcomes in neuroimaging. While Convolutional Neural Networks (CNNs) are widely used for medical image analysis, their computational complexity often hinders deployment in resource-constrained clinical settings. In contrast, our approach combines Wavelet Transform with a compact MLP to achieve efficient and accurate stroke classification. Using the "Brain Stroke MRI Images" dataset, our method yields classification accuracies of 82.0% with the "db4" wavelet (level 3 decomposition) and 86.00% with the "Haar" wavelet (level 2 decomposition). This analysis highlights a balance between diagnostic accuracy and computational efficiency, offering a practical solution for automated stroke diagnosis. Future research will focus on enhancing model robustness and integrating additional MRI modalities for comprehensive stroke assessment.
Automatic segmentation of anatomical structures is critical in medical image analysis, aiding diagnostics and treatment planning. Skin segmentation plays a key role in registering and visualising multimodal imaging data. 3D skin segmentation enables applications in personalised medicine, surgical planning, and remote monitoring, offering realistic patient models for treatment simulation, procedural visualisation, and continuous condition tracking. This paper analyses and compares algorithmic and AI-driven skin segmentation approaches, emphasising key factors to consider when selecting a strategy based on data availability and application requirements. We evaluate an iterative region-growing algorithm and the TotalSegmentator, a deep learning-based approach, across different imaging modalities and anatomical regions. Our tests show that AI segmentation excels in automation but struggles with MRI due to its CT-based training, while the graphics-based method performs better for MRIs but introduces more noise. AI-driven segmentation also automates patient bed removal in CT, whereas the graphics-based method requires manual intervention.
Artificial intelligence, including deep learning models, will play a transformative role in automated medical image analysis for the diagnosis of cardiac disorders and their management. Automated accurate delineation of cardiac images is the first necessary initial step for the quantification and automated diagnosis of cardiac disorders. In this paper, we propose a deep learning based enhanced UNet model, U-R-Veda, which integrates convolution transformations, vision transformer, residual links, channel-attention, and spatial attention, together with edge-detection based skip-connections for an accurate fully-automated semantic segmentation of cardiac magnetic resonance (CMR) images. The model extracts local-features and their interrelationships using a stack of combination convolution blocks, with embedded channel and spatial attention in the convolution block, and vision transformers. Deep embedding of channel and spatial attention in the convolution block identifies important features and their spatial localization. The combined edge information with channel and spatial attention as skip connection reduces information-loss during convolution transformations. The overall model significantly improves the semantic segmentation of CMR images necessary for improved medical image analysis. An algorithm for the dual attention module (channel and spatial attention) has been presented. Performance results show that U-R-Veda achieves an average accuracy of 95.2%, based on DSC metrics. The model outperforms the accuracy attained by other models, based on DSC and HD metrics, especially for the delineation of right-ventricle and left-ventricle-myocardium.
Accurate segmentation and classification of brain tumors from Magnetic Resonance Imaging (MRI) remain key challenges in medical image analysis, largely due to the lack of high-quality, balanced, and diverse datasets. In this work, we present a new curated MRI dataset designed specifically for brain tumor segmentation and classification tasks. The dataset comprises 6,000 contrast-enhanced T1-weighted MRI scans annotated by certified radiologists and physicians, spanning three major tumor types-glioma, meningioma, and pituitary-as well as non-tumorous cases. Each sample includes high-resolution labels and is categorized across axial, sagittal, and coronal imaging planes to facilitate robust model development and cross-view generalization. To demonstrate the utility of the dataset, we propose a transformer-based segmentation model and benchmark it against established baselines. Our method achieves the highest weighted mean Intersection-over-Union (IoU) of 82.3%, with improvements observed across all tumor categories. Importantly, this study serves primarily as an introduction to the dataset, establishing foundational benchmarks for future research. We envision this dataset as a valuable resource for advancing machine learning applications in neuro-oncology, supporting both academic research and clinical decision-support development. datasetlink: https://www.kaggle.com/datasets/briscdataset/brisc2025/
Agentic Artificial Intelligence (AI) systems leveraging Large Language Models (LLMs) exhibit significant potential for complex reasoning, planning, and tool utilization. We demonstrate that a specialized computer vision system can be built autonomously from a natural language prompt using Agentic AI methods. This involved extending SimpleMind (SM), an open-source Cognitive AI environment with configurable tools for medical image analysis, with an LLM-based agent, implemented using OpenManus, to automate the planning (tool configuration) for a particular computer vision task. We provide a proof-of-concept demonstration that an agentic system can interpret a computer vision task prompt, plan a corresponding SimpleMind workflow by decomposing the task and configuring appropriate tools. From the user input prompt, "provide sm (SimpleMind) config for lungs, heart, and ribs segmentation for cxr (chest x-ray)"), the agent LLM was able to generate the plan (tool configuration file in YAML format), and execute SM-Learn (training) and SM-Think (inference) scripts autonomously. The computer vision agent automatically configured, trained, and tested itself on 50 chest x-ray images, achieving mean dice scores of 0.96, 0.82, 0.83, for lungs, heart, and ribs, respectively. This work shows the potential for autonomous planning and tool configuration that has traditionally been performed by a data scientist in the development of computer vision applications.
Multi-modal brain magnetic resonance imaging (MRI) plays a crucial role in clinical diagnostics by providing complementary information across different imaging modalities. However, a common challenge in clinical practice is missing MRI modalities. In this paper, we apply SwinUNETR to the synthesize of missing modalities in brain MRI. SwinUNETR is a novel neural network architecture designed for medical image analysis, integrating the strengths of Swin Transformer and convolutional neural networks (CNNs). The Swin Transformer, a variant of the Vision Transformer (ViT), incorporates hierarchical feature extraction and window-based self-attention mechanisms, enabling it to capture both local and global contextual information effectively. By combining the Swin Transformer with CNNs, SwinUNETR merges global context awareness with detailed spatial resolution. This hybrid approach addresses the challenges posed by the varying modality characteristics and complex brain structures, facilitating the generation of accurate and realistic synthetic images. We evaluate the performance of SwinUNETR on brain MRI datasets and demonstrate its superior capability in generating clinically valuable images. Our results show significant improvements in image quality, anatomical consistency, and diagnostic value.
In the era of information explosion, efficiently leveraging large-scale unlabeled data while minimizing the reliance on high-quality pixel-level annotations remains a critical challenge in the field of medical imaging. Semi-supervised learning (SSL) enhances the utilization of unlabeled data by facilitating knowledge transfer, significantly improving the performance of fully supervised models and emerging as a highly promising research direction in medical image analysis. Inspired by the ability of Vision Foundation Models (e.g., SAM-2) to provide rich prior knowledge, we propose SSS (Semi-Supervised SAM-2), a novel approach that leverages SAM-2's robust feature extraction capabilities to uncover latent knowledge in unlabeled medical images, thus effectively enhancing feature support for fully supervised medical image segmentation. Specifically, building upon the single-stream "weak-to-strong" consistency regularization framework, this paper introduces a Discriminative Feature Enhancement (DFE) mechanism to further explore the feature discrepancies introduced by various data augmentation strategies across multiple views. By leveraging feature similarity and dissimilarity across multi-scale augmentation techniques, the method reconstructs and models the features, thereby effectively optimizing the salient regions. Furthermore, a prompt generator is developed that integrates Physical Constraints with a Sliding Window (PCSW) mechanism to generate input prompts for unlabeled data, fulfilling SAM-2's requirement for additional prompts. Extensive experiments demonstrate the superiority of the proposed method for semi-supervised medical image segmentation on two multi-label datasets, i.e., ACDC and BHSD. Notably, SSS achieves an average Dice score of 53.15 on BHSD, surpassing the previous state-of-the-art method by +3.65 Dice. Code will be available at https://github.com/AIGeeksGroup/SSS.
Vision-language models (VLMs) exhibit strong zero-shot generalization on natural images and show early promise in interpretable medical image analysis. However, existing benchmarks do not systematically evaluate whether these models truly reason like human clinicians or merely imitate superficial patterns. To address this gap, we propose DrVD-Bench, the first multimodal benchmark for clinical visual reasoning. DrVD-Bench consists of three modules: Visual Evidence Comprehension, Reasoning Trajectory Assessment, and Report Generation Evaluation, comprising a total of 7,789 image-question pairs. Our benchmark covers 20 task types, 17 diagnostic categories, and five imaging modalities-CT, MRI, ultrasound, radiography, and pathology. DrVD-Bench is explicitly structured to reflect the clinical reasoning workflow from modality recognition to lesion identification and diagnosis. We benchmark 19 VLMs, including general-purpose and medical-specific, open-source and proprietary models, and observe that performance drops sharply as reasoning complexity increases. While some models begin to exhibit traces of human-like reasoning, they often still rely on shortcut correlations rather than grounded visual understanding. DrVD-Bench offers a rigorous and structured evaluation framework to guide the development of clinically trustworthy VLMs.
High-quality preference data is essential for aligning foundation models with human values through preference learning. However, manual annotation of such data is often time-consuming and costly. Recent methods often adopt a self-rewarding approach, where the target model generates and annotates its own preference data, but this can lead to inaccuracies since the reward model shares weights with the target model, thereby amplifying inherent biases. To address these issues, we propose Anyprefer, a framework designed to synthesize high-quality preference data for aligning the target model. Anyprefer frames the data synthesis process as a cooperative two-player Markov Game, where the target model and the judge model collaborate together. Here, a series of external tools are introduced to assist the judge model in accurately rewarding the target model's responses, mitigating biases in the rewarding process. In addition, a feedback mechanism is introduced to optimize prompts for both models, enhancing collaboration and improving data quality. The synthesized data is compiled into a new preference dataset, Anyprefer-V1, consisting of 58K high-quality preference pairs. Extensive experiments show that Anyprefer significantly improves model alignment performance across four main applications, covering 21 datasets, achieving average improvements of 18.55% in five natural language generation datasets, 3.66% in nine vision-language understanding datasets, 30.05% in three medical image analysis datasets, and 16.00% in four visuo-motor control tasks.
In medical image analysis, feature engineering plays an important role in the design and performance of machine learning models. Persistent homology (PH), from the field of topological data analysis (TDA), demonstrates robustness and stability to data perturbations and addresses the limitation from traditional feature extraction approaches where a small change in input results in a large change in feature representation. Using PH, we store persistent topological and geometrical features in the form of the persistence barcode whereby large bars represent global topological features and small bars encapsulate geometrical information of the data. When multiple barcodes are computed from 2D or 3D medical images, two approaches can be used to construct the final topological feature vector in each dimension: aggregating persistence barcodes followed by featurization or concatenating topological feature vectors derived from each barcode. In this study, we conduct a comprehensive analysis across diverse medical imaging datasets to compare the effects of the two aforementioned approaches on the performance of classification models. The results of this analysis indicate that feature concatenation preserves detailed topological information from individual barcodes, yields better classification performance and is therefore a preferred approach when conducting similar experiments.
In recent years, Fine-Grained Visual Classification (FGVC) has achieved impressive recognition accuracy, despite minimal inter-class variations. However, existing methods heavily rely on instance-level labels, making them impractical in privacy-sensitive scenarios such as medical image analysis. This paper aims to enable accurate fine-grained recognition without direct access to instance labels. To achieve this, we leverage the Learning from Label Proportions (LLP) paradigm, which requires only bag-level labels for efficient training. Unlike existing LLP-based methods, our framework explicitly exploits the hierarchical nature of fine-grained datasets, enabling progressive feature granularity refinement and improving classification accuracy. We propose Learning from Hierarchical Fine-Grained Label Proportions (LHFGLP), a framework that incorporates Unrolled Hierarchical Fine-Grained Sparse Dictionary Learning, transforming handcrafted iterative approximation into learnable network optimization. Additionally, our proposed Hierarchical Proportion Loss provides hierarchical supervision, further enhancing classification performance. Experiments on three widely-used fine-grained datasets, structured in a bag-based manner, demonstrate that our framework consistently outperforms existing LLP-based methods. We will release our code and datasets to foster further research in privacy-preserving fine-grained classification.
This study presents a multimodal AI framework designed for precisely classifying medical diagnostic images. Utilizing publicly available datasets, the proposed system compares the strengths of convolutional neural networks (CNNs) and different large language models (LLMs). This in-depth comparative analysis highlights key differences in diagnostic performance, execution efficiency, and environmental impacts. Model evaluation was based on accuracy, F1-score, average execution time, average energy consumption, and estimated $CO_2$ emission. The findings indicate that although CNN-based models can outperform various multimodal techniques that incorporate both images and contextual information, applying additional filtering on top of LLMs can lead to substantial performance gains. These findings highlight the transformative potential of multimodal AI systems to enhance the reliability, efficiency, and scalability of medical diagnostics in clinical settings.
Multimodal learning has shown significant promise for improving medical image analysis by integrating information from complementary data sources. This is widely employed for training vision-language models (VLMs) for cancer detection based on histology images and text reports. However, one of the main limitations in training these VLMs is the requirement for large paired datasets, raising concerns over privacy, and data collection, annotation, and maintenance costs. To address this challenge, we introduce CLIP-IT method to train a vision backbone model to classify histology images by pairing them with privileged textual information from an external source. At first, the modality pairing step relies on a CLIP-based model to match histology images with semantically relevant textual report data from external sources, creating an augmented multimodal dataset without the need for manually paired samples. Then, we propose a multimodal training procedure that distills the knowledge from the paired text modality to the unimodal image classifier for enhanced performance without the need for the textual data during inference. A parameter-efficient fine-tuning method is used to efficiently address the misalignment between the main (image) and paired (text) modalities. During inference, the improved unimodal histology classifier is used, with only minimal additional computational complexity. Our experiments on challenging PCAM, CRC, and BACH histology image datasets show that CLIP-IT can provide a cost-effective approach to leverage privileged textual information and outperform unimodal classifiers for histology.