Daily Papers

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

In the field of chest X-ray (CXR) diagnosis, existing works often focus solely on determining where a radiologist looks, typically through tasks such as detection, segmentation, or classification. However, these approaches are often designed as black-box models, lacking interpretability. In this paper, we introduce Interpretable Artificial Intelligence (I-AI) a novel and unified controllable interpretable pipeline for decoding the intense focus of radiologists in CXR diagnosis. Our I-AI addresses three key questions: where a radiologist looks, how long they focus on specific areas, and what findings they diagnose. By capturing the intensity of the radiologist's gaze, we provide a unified solution that offers insights into the cognitive process underlying radiological interpretation. Unlike current methods that rely on black-box machine learning models, which can be prone to extracting erroneous information from the entire input image during the diagnosis process, we tackle this issue by effectively masking out irrelevant information. Our proposed I-AI leverages a vision-language model, allowing for precise control over the interpretation process while ensuring the exclusion of irrelevant features. To train our I-AI model, we utilize an eye gaze dataset to extract anatomical gaze information and generate ground truth heatmaps. Through extensive experimentation, we demonstrate the efficacy of our method. We showcase that the attention heatmaps, designed to mimic radiologists' focus, encode sufficient and relevant information, enabling accurate classification tasks using only a portion of CXR. The code, checkpoints, and data are at https://github.com/UARK-AICV/IAI

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Radiologists rely on eye movements to navigate and interpret medical images. A trained radiologist possesses knowledge about the potential diseases that may be present in the images and, when searching, follows a mental checklist to locate them using their gaze. This is a key observation, yet existing models fail to capture the underlying intent behind each fixation. In this paper, we introduce a deep learning-based approach, RadGazeIntent, designed to model this behavior: having an intention to find something and actively searching for it. Our transformer-based architecture processes both the temporal and spatial dimensions of gaze data, transforming fine-grained fixation features into coarse, meaningful representations of diagnostic intent to interpret radiologists' goals. To capture the nuances of radiologists' varied intention-driven behaviors, we process existing medical eye-tracking datasets to create three intention-labeled subsets: RadSeq (Systematic Sequential Search), RadExplore (Uncertainty-driven Exploration), and RadHybrid (Hybrid Pattern). Experimental results demonstrate RadGazeIntent's ability to predict which findings radiologists are examining at specific moments, outperforming baseline methods across all intention-labeled datasets.

Musculoskeletal disorders represent a significant global health burden and are a leading cause of disability worldwide. While MRI is essential for accurate diagnosis, its interpretation remains exceptionally challenging. Radiologists must identify multiple potential abnormalities within complex anatomical structures across different imaging planes, a process that requires significant expertise and is prone to variability. We developed OrthoDiffusion, a unified diffusion-based foundation model designed for multi-task musculoskeletal MRI interpretation. The framework utilizes three orientation-specific 3D diffusion models, pre-trained in a self-supervised manner on 15,948 unlabeled knee MRI scans, to learn robust anatomical features from sagittal, coronal, and axial views. These view-specific representations are integrated to support diverse clinical tasks, including anatomical segmentation and multi-label diagnosis. Our evaluation demonstrates that OrthoDiffusion achieves excellent performance in the segmentation of 11 knee structures and the detection of 8 knee abnormalities. The model exhibited remarkable robustness across different clinical centers and MRI field strengths, consistently outperforming traditional supervised models. Notably, in settings where labeled data was scarce, OrthoDiffusion maintained high diagnostic precision using only 10\% of training labels. Furthermore, the anatomical representations learned from knee imaging proved highly transferable to other joints, achieving strong diagnostic performance across 11 diseases of the ankle and shoulder. These findings suggest that diffusion-based foundation models can serve as a unified platform for multi-disease diagnosis and anatomical segmentation, potentially improving the efficiency and accuracy of musculoskeletal MRI interpretation in real-world clinical workflows.

Meningiomas are the most common primary intracranial tumor in adults and can be associated with significant morbidity and mortality. Radiologists, neurosurgeons, neuro-oncologists, and radiation oncologists rely on multiparametric MRI (mpMRI) for diagnosis, treatment planning, and longitudinal treatment monitoring; yet automated, objective, and quantitative tools for non-invasive assessment of meningiomas on mpMRI are lacking. The BraTS meningioma 2023 challenge will provide a community standard and benchmark for state-of-the-art automated intracranial meningioma segmentation models based on the largest expert annotated multilabel meningioma mpMRI dataset to date. Challenge competitors will develop automated segmentation models to predict three distinct meningioma sub-regions on MRI including enhancing tumor, non-enhancing tumor core, and surrounding nonenhancing T2/FLAIR hyperintensity. Models will be evaluated on separate validation and held-out test datasets using standardized metrics utilized across the BraTS 2023 series of challenges including the Dice similarity coefficient and Hausdorff distance. The models developed during the course of this challenge will aid in incorporation of automated meningioma MRI segmentation into clinical practice, which will ultimately improve care of patients with meningioma.

Radiologists routinely compare current and prior chest X-rays to track disease progression, producing follow-up reports that describe multiple findings, each localised to an anatomical region and annotated with a temporal change status. Existing automated methods either generate reports from a single image without modelling temporal context, or incorporate temporal information but do not ground their outputs spatially. The few approaches that combine temporal reasoning with spatial grounding are restricted to single-finding descriptions, leaving multi-finding reports with mixed change directions unaddressed. We present GRCD, a framework for grounded report generation from chest X-ray pairs in the multi-finding setting. We first construct a rigorously cleaned dataset of temporal chest X-ray pairs by identifying and correcting two systematic labelling errors in the source annotations. We then introduce a Region-Guided Change Token module that encodes per-region temporal change across anatomical structures and injects this signal into a language model through a dual-pathway strategy combining prepended spatial tokens with gated cross-attention. On a multi-finding test set, GRCD outperforms existing baselines on text generation and clinical accuracy metrics, with gains in change detection. Ablation studies confirm that the dual-pathway design outperforms either integration strategy in isolation on text and clinical metrics, and that region-level change encoding is necessary for multi-finding generation. Code is available at https://github.com/UTSA-VIRLab/GRCD

Radiologists interpret computed tomography (CT) scans by jointly determining what a finding represents and where it lies in three-dimensional (3D) anatomy. However, CT models have treated CT interpretation and 3D segmentation as separate tasks, leaving textual findings spatially unverifiable and overlooking potential synergy between clinical understanding and spatial perception. Here we present HoloCT, a generalist 3D foundation model unifying CT interpretation and voxel-level segmentation by jointly modelling whole-volume context and fine-grained anatomical detail, providing 3D masks as evidence. We curated HoloDATA, comprising 195,921 CT scans from 73 public datasets and six clinical cohorts, with 6.2 million instruction dialogues and 2.8 million CT-mask pairs. Across 346 tasks spanning segmentation, lesion screening, visual question answering, and report generation on 61 internal and 12 external datasets, HoloCT outperformed specialist and foundation models. In multicentre validation across 11,455 clinical CT scans from five hospitals, HoloCT outperformed competing models in lesion segmentation and report generation by 18.2 and 15.3 points. It also achieved 85.1% mean accuracy in screening thyroid tumours and colon lesions, exceeding all four participating radiologists in a retrospective reader study. Further analyses revealed bidirectional semantic-spatial synergy: language-guided segmentation delineated unseen anatomical structures and lesions as well as diffuse free-text findings, outperforming the leading approach by 22.1 points, whereas prompting the model to generate corresponding 3D masks alongside its textual outputs significantly improved interpretation performance. HoloCT shows that clinical understanding and spatial perception can be learned together within a single foundation model and offers a path towards more accurate and reliable CT analysis.

Building generalizable AI models is one of the primary challenges in the healthcare domain. While radiologists rely on generalizable descriptive rules of abnormality, Neural Network (NN) models suffer even with a slight shift in input distribution (e.g., scanner type). Fine-tuning a model to transfer knowledge from one domain to another requires a significant amount of labeled data in the target domain. In this paper, we develop an interpretable model that can be efficiently fine-tuned to an unseen target domain with minimal computational cost. We assume the interpretable component of NN to be approximately domain-invariant. However, interpretable models typically underperform compared to their Blackbox (BB) variants. We start with a BB in the source domain and distill it into a mixture of shallow interpretable models using human-understandable concepts. As each interpretable model covers a subset of data, a mixture of interpretable models achieves comparable performance as BB. Further, we use the pseudo-labeling technique from semi-supervised learning (SSL) to learn the concept classifier in the target domain, followed by fine-tuning the interpretable models in the target domain. We evaluate our model using a real-life large-scale chest-X-ray (CXR) classification dataset. The code is available at: https://github.com/batmanlab/MICCAI-2023-Route-interpret-repeat-CXRs.

Computed Tomography (CT) scan, which produces 3D volumetric medical data that can be viewed as hundreds of cross-sectional images (a.k.a. slices), provides detailed anatomical information for diagnosis. For radiologists, creating CT radiology reports is time-consuming and error-prone. A visual question answering (VQA) system that can answer radiologists' questions about some anatomical regions on the CT scan and even automatically generate a radiology report is urgently needed. However, existing VQA systems cannot adequately handle the CT radiology question answering (CTQA) task for: (1) anatomic complexity makes CT images difficult to understand; (2) spatial relationship across hundreds slices is difficult to capture. To address these issues, this paper proposes CT-Agent, a multimodal agentic framework for CTQA. CT-Agent adopts anatomically independent tools to break down the anatomic complexity; furthermore, it efficiently captures the across-slice spatial relationship with a global-local token compression strategy. Experimental results on two 3D chest CT datasets, CT-RATE and RadGenome-ChestCT, verify the superior performance of CT-Agent.

Understanding radiologists' eye movement during Computed Tomography (CT) reading is crucial for developing effective interpretable computer-aided diagnosis systems. However, CT research in this area has been limited by the lack of publicly available eye-tracking datasets and the three-dimensional complexity of CT volumes. To address these challenges, we present the first publicly available eye gaze dataset on CT, called CT-ScanGaze. Then, we introduce CT-Searcher, a novel 3D scanpath predictor designed specifically to process CT volumes and generate radiologist-like 3D fixation sequences, overcoming the limitations of current scanpath predictors that only handle 2D inputs. Since deep learning models benefit from a pretraining step, we develop a pipeline that converts existing 2D gaze datasets into 3D gaze data to pretrain CT-Searcher. Through both qualitative and quantitative evaluations on CT-ScanGaze, we demonstrate the effectiveness of our approach and provide a comprehensive assessment framework for 3D scanpath prediction in medical imaging.

This study presents a deep learning system for breast cancer detection in mammography, developed using a modified EfficientNetV2 architecture with enhanced attention mechanisms. The model was trained on mammograms from a major Thai medical center and validated on three distinct datasets: an in-domain test set (9,421 cases), a biopsy-confirmed set (883 cases), and an out-of-domain generalizability set (761 cases) collected from two different hospitals. For cancer detection, the model achieved AUROCs of 0.89, 0.96, and 0.94 on the respective datasets. The system's lesion localization capability, evaluated using metrics including Lesion Localization Fraction (LLF) and Non-Lesion Localization Fraction (NLF), demonstrated robust performance in identifying suspicious regions. Clinical validation through concordance tests showed strong agreement with radiologists: 83.5% classification and 84.0% localization concordance for biopsy-confirmed cases, and 78.1% classification and 79.6% localization concordance for out-of-domain cases. Expert radiologists' acceptance rate also averaged 96.7% for biopsy-confirmed cases, and 89.3% for out-of-domain cases. The system achieved a System Usability Scale score of 74.17 for source hospital, and 69.20 for validation hospitals, indicating good clinical acceptance. These results demonstrate the model's effectiveness in assisting mammogram interpretation, with the potential to enhance breast cancer screening workflows in clinical practice.

Automated structured radiology report generation (SRRG) from chest X-ray images offers significant potential to reduce workload of radiologists by generating reports in structured formats that ensure clarity, consistency, and adherence to clinical reporting standards. While radiologists effectively utilize available clinical contexts in their diagnostic reasoning, existing SRRG systems overlook these essential elements. This fundamental gap leads to critical problems including temporal hallucinations when referencing non-existent clinical contexts. To address these limitations, we propose contextualized SRRG (C-SRRG) that comprehensively incorporates rich clinical context for SRRG. We curate C-SRRG dataset by integrating comprehensive clinical context encompassing 1) multi-view X-ray images, 2) clinical indication, 3) imaging techniques, and 4) prior studies with corresponding comparisons based on patient histories. Through extensive benchmarking with state-of-the-art multimodal large language models, we demonstrate that incorporating clinical context with the proposed C-SRRG significantly improves report generation quality. We publicly release dataset, code, and checkpoints to facilitate future research for clinically-aligned automated RRG at https://github.com/vuno/contextualized-srrg.

In recent years, people from all over the world are suffering from one of the most severe diseases in history, known as Coronavirus disease 2019, COVID-19 for short. When the virus reaches the lungs, it has a higher probability to cause lung pneumonia and sepsis. X-ray image is a powerful tool in identifying the typical features of the infection for COVID-19 patients. The radiologists and pathologists observe that ground-glass opacity appears in the chest X-ray for infected patient cozzi2021ground, and it could be used as one of the criteria during the diagnosis process. In the past few years, deep learning has proven to be one of the most powerful methods in the field of image classification. Due to significant differences in Chest X-Ray between normal and infected people rousan2020chest, deep models could be used to identify the presence of the disease given a patient's Chest X-Ray. Many deep models are complex, and it evolves with lots of input parameters. Designers sometimes struggle with the tuning process for deep models, especially when they build up the model from scratch. Genetic Algorithm, inspired by the biological evolution process, plays a key role in solving such complex problems. In this paper, I proposed a genetic-based approach to optimize the Convolutional Neural Network(CNN) for the Chest X-Ray classification task.

One of the major difficulties in medical image segmentation is the high variability of these images, which is caused by their origin (multi-centre), the acquisition protocols (multi-parametric), as well as the variability of human anatomy, the severity of the illness, the effect of age and gender, among others. The problem addressed in this work is the automatic semantic segmentation of lumbar spine Magnetic Resonance images using convolutional neural networks. The purpose is to assign a class label to each pixel of an image. Classes were defined by radiologists and correspond to different structural elements like vertebrae, intervertebral discs, nerves, blood vessels, and other tissues. The proposed network topologies are variants of the U-Net architecture. Several complementary blocks were used to define the variants: Three types of convolutional blocks, spatial attention models, deep supervision and multilevel feature extractor. This document describes the topologies and analyses the results of the neural network designs that obtained the most accurate segmentations. Several of the proposed designs outperform the standard U-Net used as baseline, especially when used in ensembles where the output of multiple neural networks is combined according to different strategies.

Human readers or radiologists routinely perform full-body multi-organ multi-disease detection and diagnosis in clinical practice, while most medical AI systems are built to focus on single organs with a narrow list of a few diseases. This might severely limit AI's clinical adoption. A certain number of AI models need to be assembled non-trivially to match the diagnostic process of a human reading a CT scan. In this paper, we construct a Unified Tumor Transformer (UniT) model to detect (tumor existence and location) and diagnose (tumor characteristics) eight major cancer-prevalent organs in CT scans. UniT is a query-based Mask Transformer model with the output of multi-organ and multi-tumor semantic segmentation. We decouple the object queries into organ queries, detection queries and diagnosis queries, and further establish hierarchical relationships among the three groups. This clinically-inspired architecture effectively assists inter- and intra-organ representation learning of tumors and facilitates the resolution of these complex, anatomically related multi-organ cancer image reading tasks. UniT is trained end-to-end using a curated large-scale CT images of 10,042 patients including eight major types of cancers and occurring non-cancer tumors (all are pathology-confirmed with 3D tumor masks annotated by radiologists). On the test set of 631 patients, UniT has demonstrated strong performance under a set of clinically relevant evaluation metrics, substantially outperforming both multi-organ segmentation methods and an assembly of eight single-organ expert models in tumor detection, segmentation, and diagnosis. Such a unified multi-cancer image reading model (UniT) can significantly reduce the number of false positives produced by combined multi-system models. This moves one step closer towards a universal high-performance cancer screening tool.

We develop an algorithm that can detect pneumonia from chest X-rays at a level exceeding practicing radiologists. Our algorithm, CheXNet, is a 121-layer convolutional neural network trained on ChestX-ray14, currently the largest publicly available chest X-ray dataset, containing over 100,000 frontal-view X-ray images with 14 diseases. Four practicing academic radiologists annotate a test set, on which we compare the performance of CheXNet to that of radiologists. We find that CheXNet exceeds average radiologist performance on the F1 metric. We extend CheXNet to detect all 14 diseases in ChestX-ray14 and achieve state of the art results on all 14 diseases.

Accurate prostate cancer diagnosis remains challenging. Even when using MRI, radiologists exhibit low specificity and significant inter-observer variability, leading to potential delays or inaccuracies in identifying clinically significant cancers. This leads to numerous unnecessary biopsies and risks of missing clinically significant cancers. Here we present prostate vision contrastive network (ProViCNet), prostate organ-specific vision foundation models for Magnetic Resonance Imaging (MRI) and Trans-Rectal Ultrasound imaging (TRUS) for comprehensive cancer detection. ProViCNet was trained and validated using 4,401 patients across six institutions, as a prostate cancer detection model on radiology images relying on patch-level contrastive learning guided by biopsy confirmed radiologist annotations. ProViCNet demonstrated consistent performance across multiple internal and external validation cohorts with area under the receiver operating curve values ranging from 0.875 to 0.966, significantly outperforming radiologists in the reader study (0.907 versus 0.805, p<0.001) for mpMRI, while achieving 0.670 to 0.740 for TRUS. We also integrated ProViCNet with standard PSA to develop a virtual screening test, and we showed that we can maintain the high sensitivity for detecting clinically significant cancers while more than doubling specificity from 15% to 38% (p<0.001), thereby substantially reducing unnecessary biopsies. These findings highlight that ProViCNet's potential for enhancing prostate cancer diagnosis accuracy and reduce unnecessary biopsies, thereby optimizing diagnostic pathways.

As medical datasets rapidly expand, creating detailed annotations of different body structures becomes increasingly expensive and time-consuming. We consider that requesting radiologists to create detailed annotations is unnecessarily burdensome and that pre-existing AI models can largely automate this process. Following the spirit don't use a sledgehammer on a nut, we find that, rather than creating annotations from scratch, radiologists only have to review and edit errors if the Best-AI Labels have mistakes. To obtain the Best-AI Labels among multiple AI Labels, we developed an automatic tool, called Label Critic, that can assess label quality through tireless pairwise comparisons. Extensive experiments demonstrate that, when incorporated with our developed Image-Prompt pairs, pre-existing Large Vision-Language Models (LVLM), trained on natural images and texts, achieve 96.5% accuracy when choosing the best label in a pair-wise comparison, without extra fine-tuning. By transforming the manual annotation task (30-60 min/scan) into an automatic comparison task (15 sec/scan), we effectively reduce the manual efforts required from radiologists by an order of magnitude. When the Best-AI Labels are sufficiently accurate (81% depending on body structures), they will be directly adopted as the gold-standard annotations for the dataset, with lower-quality AI Labels automatically discarded. Label Critic can also check the label quality of a single AI Label with 71.8% accuracy when no alternatives are available for comparison, prompting radiologists to review and edit if the estimated quality is low (19% depending on body structures).

The rapid increase of computed tomography (CT) scans and their time-consuming manual analysis have created an urgent need for robust automated analysis techniques in clinical settings. These aim to assist radiologists and help them managing their growing workload. Existing methods typically generate entire reports directly from 3D CT images, without explicitly focusing on observed abnormalities. This unguided approach often results in repetitive content or incomplete reports, failing to prioritize anomaly-specific descriptions. We propose a new anomaly-guided report generation model, which first predicts abnormalities and then generates targeted descriptions for each. Evaluation on a public dataset demonstrates significant improvements in report quality and clinical relevance. We extend our work by conducting an ablation study to demonstrate its effectiveness.

Glioblastomas are the most aggressive type of glioma, having a 5-year survival rate of 6.9%. Treatment typically involves surgery, followed by radiotherapy and chemotherapy, and frequent magnetic resonance imaging (MRI) scans to monitor disease progression. To assess treatment response, radiologists use the Response Assessment in Neuro-Oncology (RANO) criteria to categorize the tumor into one of four labels based on imaging and clinical features: complete response, partial response, stable disease, and progressive disease. This assessment is very complex and time-consuming. Since deep learning (DL) has been widely used to tackle classification problems, this work aimed to implement the first DL pipeline for the classification of RANO criteria based on two consecutive MRI acquisitions. The models were trained and tested on the open dataset LUMIERE. Five approaches were tested: 1) subtraction of input images, 2) different combinations of modalities, 3) different model architectures, 4) different pretraining tasks, and 5) adding clinical data. The pipeline that achieved the best performance used a Densenet264 considering only T1-weighted, T2-weighted, and Fluid Attenuated Inversion Recovery (FLAIR) images as input without any pretraining. A median Balanced Accuracy of 50.96% was achieved. Additionally, explainability methods were applied. Using Saliency Maps, the tumor region was often successfully highlighted. In contrast, Grad-CAM typically failed to highlight the tumor region, with some exceptions observed in the Complete Response and Progressive Disease classes, where it effectively identified the tumor region. These results set a benchmark for future studies on glioblastoma treatment response assessment based on the RANO criteria while emphasizing the heterogeneity of factors that might play a role when assessing the tumor's response to treatment.

Pan-cancer screening in large-scale CT scans remains challenging for existing AI methods, primarily due to the difficulty of localizing diverse types of tiny lesions in large CT volumes. The extreme foreground-background imbalance significantly hinders models from focusing on diseased regions, while redundant focus on healthy regions not only decreases the efficiency but also increases false positives. Inspired by radiologists' glance and focus diagnostic strategy, we introduce GF-Screen, a Glance and Focus reinforcement learning framework for pan-cancer screening. GF-Screen employs a Glance model to localize the diseased regions and a Focus model to precisely segment the lesions, where segmentation results of the Focus model are leveraged to reward the Glance model via Reinforcement Learning (RL). Specifically, the Glance model crops a group of sub-volumes from the entire CT volume and learns to select the sub-volumes with lesions for the Focus model to segment. Given that the selecting operation is non-differentiable for segmentation training, we propose to employ the segmentation results to reward the Glance model. To optimize the Glance model, we introduce a novel group relative learning paradigm, which employs group relative comparison to prioritize high-advantage predictions and discard low-advantage predictions within sub-volume groups, not only improving efficiency but also reducing false positives. In this way, for the first time, we effectively extend cutting-edge RL techniques to tackle the specific challenges in pan-cancer screening. Extensive experiments on 16 internal and 7 external datasets across 9 lesion types demonstrated the effectiveness of GF-Screen. Notably, GF-Screen leads the public validation leaderboard of MICCAI FLARE25 pan-cancer challenge, surpassing the FLARE24 champion solution by a large margin (+25.6% DSC and +28.2% NSD).

The application of ionizing radiation for diagnostic imaging is common around the globe. However, the process of imaging, itself, remains to be a relatively hazardous operation. Therefore, it is preferable to use as low a dose of ionizing radiation as possible, particularly in computed tomography (CT) imaging systems, where multiple x-ray operations are performed for the reconstruction of slices of body tissues. A popular method for radiation dose reduction in CT imaging is known as the quarter-dose technique, which reduces the x-ray dose but can cause a loss of image sharpness. Since CT image reconstruction from directional x-rays is a nonlinear process, it is analytically difficult to correct the effect of dose reduction on image quality. Recent and popular deep-learning approaches provide an intriguing possibility of image enhancement for low-dose artifacts. Some recent works propose combinations of multiple deep-learning and classical methods for this purpose, which over-complicate the process. However, it is observed here that the straight utilization of the well-known U-NET provides very successful results for the correction of low-dose artifacts. Blind tests with actual radiologists reveal that the U-NET enhanced quarter-dose CT images not only provide an immense visual improvement over the low-dose versions, but also become diagnostically preferable images, even when compared to their full-dose CT versions.

Chest X-rays (CXRs) are among the most frequently performed imaging examinations worldwide, yet rising imaging volumes increase radiologist workload and the risk of diagnostic errors. Although artificial intelligence (AI) systems have shown promise for CXR interpretation, most generate only final predictions, without making explicit how visual evidence is translated into radiographic findings and diagnostic predictions. We present CheXOne, a reasoning-enabled vision-language model for CXR interpretation. CheXOne jointly generates diagnostic predictions and explicit, clinically grounded reasoning traces that connect visual evidence, radiographic findings, and these predictions. The model is trained on 14.7 million instruction and reasoning samples curated from 30 public datasets spanning 36 CXR interpretation tasks, using a two-stage framework that combines instruction tuning with reinforcement learning to improve reasoning quality. We evaluate CheXOne in zero-shot settings across visual question answering, report generation, visual grounding and reasoning assessment, covering 17 evaluation settings. CheXOne outperforms existing medical and general-domain foundation models and achieves strong performance on independent public benchmarks. A clinical reader study demonstrates that CheXOne-drafted reports are comparable to or better than resident-written reports in 55% of cases, while effectively addressing clinical indications and enhancing both report writing and CXR interpretation efficiency. Further analyses involving radiologists reveal that the generated reasoning traces show high clinical factuality and provide causal support for the final predictions, offering a plausible explanation for the performance gains. These results suggest that explicit reasoning can improve model performance, interpretability and clinical utility in AI-assisted CXR interpretation.

Chest X-ray (CXR) radiology report generation (RRG) models have shown rapid progress, yet their clinical utility remains uncertain due to limited evaluation by radiologists. We present CXRMate-2, a state-of-the-art CXR RRG model that integrates structured multimodal conditioning and reinforcement learning with a composite reward for semantic alignment with radiologist reports. Across the MIMIC-CXR, CheXpert Plus, and ReXgradient datasets, CXRMate-2 achieves statistically significant improvements over strong benchmarks, including gains of 11.2% and 24.4% in GREEN and RadGraph-XL, respectively, on MIMIC-CXR relative to MedGemma 1.5 (4B). To directly compare CXRMate-2 against radiologist reporting, we conduct a blinded, randomised qualitative retrospective evaluation. Three consultant radiologists compare generated and radiologist reports across 120 studies from the MIMIC-CXR test set. Generated reports were deemed acceptable (defined as preferred or rated equally to radiologist reports) in 45% of ratings, with no statistically significant difference in preference rates between radiologist reports and acceptable generated reports for seven of the eight analysed findings. Preference for radiologist reports was driven primarily by higher recall, while generated reports were often preferred for readability. Together, these results suggest a credible pathway to clinically acceptable CXR RRG. Improvements in recall, alongside better detection of subtle findings (e.g., pulmonary congestion), are likely sufficient to achieve non-inferiority to radiologist reporting. With these targeted advances, CXR RRG systems may be ready for prospective evaluation in assistive roles within radiologist-led workflows.

Recent 3D CT vision-language models align volumes with reports via contrastive pretraining, but typically rely on limited public data and provide only coarse global supervision. We train a 3D CT vision-language model on 98k report-volume pairs (50k patients) collected at a single hospital, combined with public datasets, using SigLIP-style contrastive pretraining together with prompt-based disease supervision in the shared vision-text embedding space. On CT-RATE, our model achieves state-of-the-art text-to-image retrieval (R@10 31.5 vs. 22.2) and competitive disease classification (AUC 83.8 vs. 83.8), with consistent results on Rad-ChestCT (AUC 77.0 vs. 77.3). We further observe that radiologists routinely reference specific images within their reports (e.g., ``series X, image Y''), linking textual descriptions to precise axial locations. We automatically mine 262k such snippet-slice pairs and introduce the task of intra-scan snippet localization -- predicting the axial depth referred to by a text snippet -- reducing mean absolute error to 36.3 mm at 12 mm feature resolution, compared with 67.0 mm for the best baseline. Adding this localization objective leaves retrieval and classification broadly unchanged within confidence bounds, yielding a single unified model for retrieval, classification, and intra-scan grounding.

Medical vision-language models report strong chest radiograph accuracy, and this is increasingly read as evidence that they use the image. That inference is unsafe: a model exploiting finding-name priors scores like one that reads the scan, and no standard benchmark separates them. We introduce a causal audit that intervenes on the image, occluding the relevant region, occluding an irrelevant one, and swapping in another patient's same-label scan, and combines three behavioral metrics to test whether a correct answer depends on the image. Across nine systems, a text-only model with no image access reaches within 5.7 accuracy points of the best multimodal one, and a 119-billion-parameter multimodal model is statistically indistinguishable from a 7-billion text-only baseline. The audit splits the cohort into three models that ignore the image, one that is unstable, and five that use it selectively, for a subset of findings; the categories hold across a second dataset, resolution, and prompt phrasing. Against board-certified radiologists, a text-only model is statistically indistinguishable from a radiologist's accuracy while grounding at zero, whereas the image-using models ground at radiologist-comparable rates. Reported confidence flags ungrounded answers only when a model uses the image. Grounding audits, not accuracy, should gate clinical deployment.

Incidental findings in CT scans, though often benign, can have significant clinical implications and should be reported following established guidelines. Traditional manual inspection by radiologists is time-consuming and variable. This paper proposes a novel framework that leverages large language models (LLMs) and foundational vision-language models (VLMs) in a plan-and-execute agentic approach to improve the efficiency and precision of incidental findings detection, classification, and reporting for abdominal CT scans. Given medical guidelines for abdominal organs, the process of managing incidental findings is automated through a planner-executor framework. The planner, based on LLM, generates Python scripts using predefined base functions, while the executor runs these scripts to perform the necessary checks and detections, via VLMs, segmentation models, and image processing subroutines. We demonstrate the effectiveness of our approach through experiments on a CT abdominal benchmark for three organs, in a fully automatic end-to-end manner. Our results show that the proposed framework outperforms existing pure VLM-based approaches in terms of accuracy and efficiency.

Pancreatic cancer is projected to be the second-deadliest cancer by 2030, making early detection critical. Intraductal papillary mucinous neoplasms (IPMNs), key cancer precursors, present a clinical dilemma, as current guidelines struggle to stratify malignancy risk, leading to unnecessary surgeries or missed diagnoses. Here, we introduce Cyst-X, a multi-center MRI benchmark and a federated learning framework for IPMN malignancy-risk stratification. The dataset comprises 1,461 abdominal MRI scans from 764 patients at seven international centers, with three-tier malignancy labels anchored in histopathology or three-year imaging follow-up and expert pancreas segmentations. The pipeline couples the PanSegNet pancreas segmenter with a 3D DenseNet-121 classifier and a parallel radiomics predictor. On internal cross-validation, the deep learning classifier reached a mean area under the receiver operating characteristic curve (AUC) of 0.85 (95% confidence interval 0.84-0.86) on T2-weighted MRI for high-risk versus low- or no-risk discrimination, with the average precision rising from a prevalence baseline of 0.23 to 0.64. This performance was preserved (AUC 0.85, FedProx) when training was distributed across institutions without exchange of raw patient images. Benchmarked against three blinded radiologists on a 629-case reader subset evaluated under imaging-only conditions, the classifier matched or exceeded sensitivity at comparable specificity. To accelerate research in early pancreatic cancer detection, we publicly release the Cyst-X dataset, segmentation masks, and trained models as the first large-scale, multi-centre MRI resource for pancreatic cystic neoplasm analysis.

Automating radiology report generation can significantly alleviate radiologists' workloads. Previous research has primarily focused on realizing highly concise observations while neglecting the precise attributes that determine the severity of diseases (e.g., small pleural effusion). Since incorrect attributes will lead to imprecise radiology reports, strengthening the generation process with precise attribute modeling becomes necessary. Additionally, the temporal information contained in the historical records, which is crucial in evaluating a patient's current condition (e.g., heart size is unchanged), has also been largely disregarded. To address these issues, we propose RECAP, which generates precise and accurate radiology reports via dynamic disease progression reasoning. Specifically, RECAP first predicts the observations and progressions (i.e., spatiotemporal information) given two consecutive radiographs. It then combines the historical records, spatiotemporal information, and radiographs for report generation, where a disease progression graph and dynamic progression reasoning mechanism are devised to accurately select the attributes of each observation and progression. Extensive experiments on two publicly available datasets demonstrate the effectiveness of our model.

We introduce MURA, a large dataset of musculoskeletal radiographs containing 40,561 images from 14,863 studies, where each study is manually labeled by radiologists as either normal or abnormal. To evaluate models robustly and to get an estimate of radiologist performance, we collect additional labels from six board-certified Stanford radiologists on the test set, consisting of 207 musculoskeletal studies. On this test set, the majority vote of a group of three radiologists serves as gold standard. We train a 169-layer DenseNet baseline model to detect and localize abnormalities. Our model achieves an AUROC of 0.929, with an operating point of 0.815 sensitivity and 0.887 specificity. We compare our model and radiologists on the Cohen's kappa statistic, which expresses the agreement of our model and of each radiologist with the gold standard. Model performance is comparable to the best radiologist performance in detecting abnormalities on finger and wrist studies. However, model performance is lower than best radiologist performance in detecting abnormalities on elbow, forearm, hand, humerus, and shoulder studies. We believe that the task is a good challenge for future research. To encourage advances, we have made our dataset freely available at https://stanfordmlgroup.github.io/competitions/mura .

Segmentation of biomedical images can assist radiologists to make a better diagnosis and take decisions faster by helping in the detection of abnormalities, such as tumors. Manual or semi-automated segmentation, however, can be a time-consuming task. Most deep learning based automated segmentation methods are supervised and rely on manually segmented ground-truth. A possible solution for the problem would be an unsupervised deep learning based approach for automated segmentation, which this research work tries to address. We use a W-Net architecture and modified it, such that it can be applied to 3D volumes. In addition, to suppress noise in the segmentation we added attention gates to the skip connections. The loss for the segmentation output was calculated using soft N-Cuts and for the reconstruction output using SSIM. Conditional Random Fields were used as a post-processing step to fine-tune the results. The proposed method has shown promising results, with a dice coefficient of 0.88 for the liver segmentation compared against manual segmentation.

Radiology reporting generative AI holds significant potential to alleviate clinical workloads and streamline medical care. However, achieving high clinical accuracy is challenging, as radiological images often feature subtle lesions and intricate structures. Existing systems often fall short, largely due to their reliance on fixed size, patch-level image features and insufficient incorporation of pathological information. This can result in the neglect of such subtle patterns and inconsistent descriptions of crucial pathologies. To address these challenges, we propose an innovative approach that leverages pathology-aware regional prompts to explicitly integrate anatomical and pathological information of various scales, significantly enhancing the precision and clinical relevance of generated reports. We develop an anatomical region detector that extracts features from distinct anatomical areas, coupled with a novel multi-label lesion detector that identifies global pathologies. Our approach emulates the diagnostic process of radiologists, producing clinically accurate reports with comprehensive diagnostic capabilities. Experimental results show that our model outperforms previous state-of-the-art methods on most natural language generation and clinical efficacy metrics, with formal expert evaluations affirming its potential to enhance radiology practice.

AI-assisted radiological interpretation is based on predominantly narrow, single-task models. This approach is impractical for covering the vast spectrum of imaging modalities, diseases, and radiological findings. Foundation models (FMs) hold the promise of broad generalization across modalities and in low-data settings. However, this potential has remained largely unrealized in radiology. We introduce Curia, a foundation model trained on the entire cross-sectional imaging output of a major hospital over several years, which to our knowledge is the largest such corpus of real-world data-encompassing 150,000 exams (130 TB). On a newly curated 19-task external validation benchmark, Curia accurately identifies organs, detects conditions like brain hemorrhages and myocardial infarctions, and predicts outcomes in tumor staging. Curia meets or surpasses the performance of radiologists and recent foundation models, and exhibits clinically significant emergent properties in cross-modality, and low-data regimes. To accelerate progress, we release our base model's weights at https://huggingface.co/raidium/curia.

Chest X-ray imaging is crucial for diagnosing pulmonary and cardiac diseases, yet its interpretation demands extensive clinical experience and suffers from inter-observer variability. While deep learning models offer high diagnostic accuracy, their black-box nature hinders clinical adoption in high-stakes medical settings. To address this, we propose X-Ray-CoT (Chest X-Ray Chain-of-Thought), a novel framework leveraging Vision-Language Large Models (LVLMs) for intelligent chest X-ray diagnosis and interpretable report generation. X-Ray-CoT simulates human radiologists' "chain-of-thought" by first extracting multi-modal features and visual concepts, then employing an LLM-based component with a structured Chain-of-Thought prompting strategy to reason and produce detailed natural language diagnostic reports. Evaluated on the CORDA dataset, X-Ray-CoT achieves competitive quantitative performance, with a Balanced Accuracy of 80.52% and F1 score of 78.65% for disease diagnosis, slightly surpassing existing black-box models. Crucially, it uniquely generates high-quality, explainable reports, as validated by preliminary human evaluations. Our ablation studies confirm the integral role of each proposed component, highlighting the necessity of multi-modal fusion and CoT reasoning for robust and transparent medical AI. This work represents a significant step towards trustworthy and clinically actionable AI systems in medical imaging.

Dynamic contrast-enhanced (DCE) MRI is essential for breast cancer diagnosis and treatment. However, its reliance on contrast agents introduces safety concerns, contraindications, increased cost, and workflow complexity. To this end, we present pre-contrast conditioned denoising diffusion probabilistic models to synthesize DCE-MRI, introducing, evaluating, and comparing a total of 22 generative model variants in both single-breast and full breast settings. Towards enhancing lesion fidelity, we introduce both tumor-aware loss functions and explicit tumor segmentation mask conditioning. Using a public multicenter dataset and comparing to respective pre-contrast baselines, we observe that subtraction image-based models consistently outperform post-contrast-based models across five complementary evaluation metrics. Apart from assessing the entire image, we also separately evaluate the region of interest, where both tumor-aware losses and segmentation mask inputs improve evaluation metrics. The latter notably enhance qualitative results capturing contrast uptake, albeit assuming access to tumor localization inputs that are not guaranteed to be available in screening settings. A reader study involving 2 radiologists and 4 MRI technologists confirms the high realism of the synthetic images, indicating an emerging clinical potential of generative contrast-enhancement. We share our codebase at https://github.com/sebastibar/conditional-diffusion-breast-MRI.

This study evaluates the effect of counterfactual explanations on the interpretation of chest X-rays. We conduct a reader study with two radiologists assessing 240 chest X-ray predictions to rate their confidence that the model's prediction is correct using a 5 point scale. Half of the predictions are false positives. Each prediction is explained twice, once using traditional attribution methods and once with a counterfactual explanation. The overall results indicate that counterfactual explanations allow a radiologist to have more confidence in true positive predictions compared to traditional approaches (0.15pm0.95 with p=0.01) with only a small increase in false positive predictions (0.04pm1.06 with p=0.57). We observe the specific prediction tasks of Mass and Atelectasis appear to benefit the most compared to other tasks.

Background: Thyroid ultrasound is commonly performed using a combination of static images and cine clips (video recordings). However, the exact utility and impact of cine images remains unknown. This study aimed to evaluate the impact of cine imaging on accuracy and consistency of thyroid nodule assessment, using the American College of Radiology Thyroid Reporting and Data System (ACR TI-RADS). Methods: 50 benign and 50 malignant thyroid nodules with cytopathology results were included. A reader study with 4 specialty-trained radiologists was then conducted over 3 rounds, assessing only static images in the first two rounds and both static and cine images in the third round. TI-RADS scores and the consequent management recommendations were then evaluated by comparing them to the malignancy status of the nodules. Results: Mean sensitivity for malignancy detection was 0.65 for static images and 0.67 with both static and cine images (p>0.5). Specificity was 0.20 for static images and 0.22 with both static and cine images (p>0.5). Management recommendations were similar with and without cine images. Intrareader agreement on feature assignments remained consistent across all rounds, though TI-RADS point totals were slightly higher with cine images. Conclusion: The inclusion of cine imaging for thyroid nodule assessment on ultrasound did not significantly change diagnostic performance. Current practice guidelines, which do not mandate cine imaging, are sufficient for accurate diagnosis.

Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment. In this paper, we introduce ClinFusion, a vision-centric MLLM designed for holistic medical understanding that systematically addresses these limitations. We propose a compositional and cascaded vision encoder architecture featuring a Cascade Spatial-Aware Locality Fusion operator that unifies diverse 2D and native 3D medical image understanding within a fused encoder. We further introduce a vision-grounded evaluation framework, including MedIF-Bench for instruction-following assessment and a region-of-interest-grounded method for clinically aligned and factualness-driven report generation evaluation. We show that ClinFusion sets a new state-of-the-art across a comprehensive suite of 2D and 3D multimodal medical benchmarks---spanning visual question answering, report generation, and instruction following---as well as textual medical tasks, outperforming leading open-source medical MLLMs (e.g., Hulu-Med, Lingshu) on 20 out of 24 benchmarks and demonstrating multimodal capabilities better than powerful proprietary models such as GPT-5.2 and Gemini-3-Flash on 13 out of 16 benchmarks, and can be further augmented with agentic tool use for retrieval-augmented and tool-assisted clinical workflows. A blinded evaluation by board-certified radiologists confirms that ClinFusion produces the highest-ranked reports, and validates our RoI-grounded metric as achieving the strongest correlation with expert judgment among all automatic evaluation metrics examined.

In 2018, clinics and hospitals were hit with numerous attacks leading to significant data breaches and interruptions in medical services. An attacker with access to medical records can do much more than hold the data for ransom or sell it on the black market. In this paper, we show how an attacker can use deep-learning to add or remove evidence of medical conditions from volumetric (3D) medical scans. An attacker may perform this act in order to stop a political candidate, sabotage research, commit insurance fraud, perform an act of terrorism, or even commit murder. We implement the attack using a 3D conditional GAN and show how the framework (CT-GAN) can be automated. Although the body is complex and 3D medical scans are very large, CT-GAN achieves realistic results which can be executed in milliseconds. To evaluate the attack, we focused on injecting and removing lung cancer from CT scans. We show how three expert radiologists and a state-of-the-art deep learning AI are highly susceptible to the attack. We also explore the attack surface of a modern radiology network and demonstrate one attack vector: we intercepted and manipulated CT scans in an active hospital network with a covert penetration test. Demo video: https://youtu.be/_mkRAArj-x0 Source code: https://github.com/ymirsky/CT-GAN

Medical image annotation is essential for diagnosing diseases, yet manual annotation is time-consuming, costly, and prone to variability among experts. To address these challenges, we propose an automated explainable annotation system that integrates ensemble learning, visual explainability, and uncertainty quantification. Our approach combines three pre-trained deep learning models - ResNet50, EfficientNet, and DenseNet - enhanced with XGrad-CAM for visual explanations and Monte Carlo Dropout for uncertainty quantification. This ensemble mimics the consensus of multiple radiologists by intersecting saliency maps from models that agree on the diagnosis while uncertain predictions are flagged for human review. We evaluated our system using the TBX11K medical imaging dataset and a Fire segmentation dataset, demonstrating its robustness across different domains. Experimental results show that our method outperforms baseline models, achieving 93.04% accuracy on TBX11K and 96.4% accuracy on the Fire dataset. Moreover, our model produces precise pixel-level annotations despite being trained with only image-level labels, achieving Intersection over Union IoU scores of 36.07% and 64.7%, respectively. By enhancing the accuracy and interpretability of image annotations, our approach offers a reliable and transparent solution for medical diagnostics and other image analysis tasks.

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

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.

Purpose: To evaluate whether large language model (LLM)-assisted label cleaning can identify label-report discordance in CT-RATE, a large-scale public chest CT dataset. Materials and Methods: After report-level deduplication, 24,446 unique radiology reports were identified. Twelve reports were excluded from the primary GPT-5.4 analysis because of Microsoft Azure AI Foundry content-safety filtering, leaving 24,434 reports and 439,812 label instances across 18 abnormality categories. GPT-5.4-derived binary labels were generated from report text using structured JSON output and compared with existing CT-RATE labels. Discordant instances were adjudicated by radiologists. In addition, 100 randomly sampled reports were manually annotated to compare CT-RATE labels, individual LLM-derived labels, and multi-LLM majority-vote labels against radiologist-annotated reference labels. Results: Overall agreement between GPT-5.4-derived and CT-RATE labels was 96.4%, with Cohen's kappa of 0.884. Lymphadenopathy showed the lowest agreement and kappa. In discordance review, radiologist adjudication supported GPT-5.4-derived labels in 72 of 97 (74.2%) general discordant instances and 91 of 99 (91.9%) targeted lymphadenopathy discordant instances. Against radiologist-annotated reference labels, multi-LLM majority-vote labels achieved the highest label-macro-averaged F1 score and Cohen's kappa. Conclusion: LLM-assisted label cleaning identified clinically meaningful label-report discordance in CT-RATE and may support scalable quality improvement of public imaging datasets. The cleaned dataset will be made publicly available to support future research.

When reading medical images such as a computed tomography (CT) scan, radiologists generally search across the image to find lesions, characterize and measure them, and then describe them in the radiological report. To automate this process, we propose a multitask universal lesion analysis network (MULAN) for joint detection, tagging, and segmentation of lesions in a variety of body parts, which greatly extends existing work of single-task lesion analysis on specific body parts. MULAN is based on an improved Mask R-CNN framework with three head branches and a 3D feature fusion strategy. It achieves the state-of-the-art accuracy in the detection and tagging tasks on the DeepLesion dataset, which contains 32K lesions in the whole body. We also analyze the relationship between the three tasks and show that tag predictions can improve detection accuracy via a score refinement layer.

Breast cancer is a major cause of cancer death among women, emphasising the importance of early detection for improved treatment outcomes and quality of life. Mammography, the primary diagnostic imaging test, poses challenges due to the high variability and patterns in mammograms. Double reading of mammograms is recommended in many screening programs to improve diagnostic accuracy but increases radiologists' workload. Researchers explore Machine Learning models to support expert decision-making. Stand-alone models have shown comparable or superior performance to radiologists, but some studies note decreased sensitivity with multiple datasets, indicating the need for high generalisation and robustness models. This work devises MammoDG, a novel deep-learning framework for generalisable and reliable analysis of cross-domain multi-center mammography data. MammoDG leverages multi-view mammograms and a novel contrastive mechanism to enhance generalisation capabilities. Extensive validation demonstrates MammoDG's superiority, highlighting the critical importance of domain generalisation for trustworthy mammography analysis in imaging protocol variations.

Medical imaging is critical to the diagnosis and treatment of numerous medical problems, including many forms of cancer. Medical imaging reports distill the findings and observations of radiologists, creating an unstructured textual representation of unstructured medical images. Large-scale use of this text-encoded information requires converting the unstructured text to a structured, semantic representation. We explore the extraction and normalization of anatomical information in radiology reports that is associated with radiological findings. We investigate this extraction and normalization task using a span-based relation extraction model that jointly extracts entities and relations using BERT. This work examines the factors that influence extraction and normalization performance, including the body part/organ system, frequency of occurrence, span length, and span diversity. It discusses approaches for improving performance and creating high-quality semantic representations of radiological phenomena.

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing CheXinstruct - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present CheXagent - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce CheXbench - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at https://stanford-aimi.github.io/chexagent.html.

Breast ultrasound (BUS) is a critical diagnostic tool in the field of breast imaging, aiding in the early detection and characterization of breast abnormalities. Interpreting breast ultrasound images commonly involves creating comprehensive medical reports, containing vital information to promptly assess the patient's condition. However, the ultrasound imaging system necessitates capturing multiple images of various parts to compile a single report, presenting a time-consuming challenge. To address this problem, we propose the integration of multiple image analysis tools through a LangChain using Large Language Models (LLM), into the breast reporting process. Through a combination of designated tools and text generation through LangChain, our method can accurately extract relevant features from ultrasound images, interpret them in a clinical context, and produce comprehensive and standardized reports. This approach not only reduces the burden on radiologists and healthcare professionals but also enhances the consistency and quality of reports. The extensive experiments shows that each tools involved in the proposed method can offer qualitatively and quantitatively significant results. Furthermore, clinical evaluation on the generated reports demonstrates that the proposed method can make report in clinically meaningful way.

Radiology report generation (RRG) has attracted significant attention due to its potential to reduce the workload of radiologists. Current RRG approaches are still unsatisfactory against clinical standards. This paper introduces a novel RRG method, LM-RRG, that integrates large models (LMs) with clinical quality reinforcement learning to generate accurate and comprehensive chest X-ray radiology reports. Our method first designs a large language model driven feature extractor to analyze and interpret different regions of the chest X-ray image, emphasizing specific regions with medical significance. Next, based on the large model's decoder, we develop a multimodal report generator that leverages multimodal prompts from visual features and textual instruction to produce the radiology report in an auto-regressive way. Finally, to better reflect the clinical significant and insignificant errors that radiologists would normally assign in the report, we introduce a novel clinical quality reinforcement learning strategy. It utilizes the radiology report clinical quality (RadCliQ) metric as a reward function in the learning process. Extensive experiments on the MIMIC-CXR and IU-Xray datasets demonstrate the superiority of our method over the state of the art.

Radiology reports are one of the main forms of communication between radiologists and other clinicians and contain important information for patient care. In order to use this information for research and automated patient care programs, it is necessary to convert the raw text into structured data suitable for analysis. State-of-the-art natural language processing (NLP) domain-specific contextual word embeddings have been shown to achieve impressive accuracy for these tasks in medicine, but have yet to be utilized for section structure segmentation. In this work, we pre-trained a contextual embedding BERT model using breast radiology reports and developed a classifier that incorporated the embedding with auxiliary global textual features in order to perform section segmentation. This model achieved a 98% accuracy at segregating free text reports sentence by sentence into sections of information outlined in the Breast Imaging Reporting and Data System (BI-RADS) lexicon, a significant improvement over the Classic BERT model without auxiliary information. We then evaluated whether using section segmentation improved the downstream extraction of clinically relevant information such as modality/procedure, previous cancer, menopausal status, the purpose of the exam, breast density, and breast MRI background parenchymal enhancement. Using the BERT model pre-trained on breast radiology reports combined with section segmentation resulted in an overall accuracy of 95.9% in the field extraction tasks. This is a 17% improvement compared to an overall accuracy of 78.9% for field extraction with models using Classic BERT embeddings and not using section segmentation. Our work shows the strength of using BERT in radiology report analysis and the advantages of section segmentation in identifying key features of patient factors recorded in breast radiology reports.

Quantitative tools are increasingly appealing for decision support in healthcare, driven by the growing capabilities of advanced AI systems. However, understanding the predictive uncertainties surrounding a tool's output is crucial for decision-makers to ensure reliable and transparent decisions. In this paper, we present a case study on pulmonary nodule detection for lung cancer screening, enhancing an advanced detection model with an uncertainty quantification technique called conformal risk control (CRC). We demonstrate that prediction sets with conformal guarantees are attractive measures of predictive uncertainty in the safety-critical healthcare domain, allowing end-users to achieve arbitrary validity by trading off false positives and providing formal statistical guarantees on model performance. Among ground-truth nodules annotated by at least three radiologists, our model achieves a sensitivity that is competitive with that generally achieved by individual radiologists, with a slight increase in false positives. Furthermore, we illustrate the risks of using off-the-shelve prediction models when faced with ontological uncertainty, such as when radiologists disagree on what constitutes the ground truth on pulmonary nodules.

Reading and interpreting chest X-ray images is one of the most radiologist's routines. However, it still can be challenging, even for the most experienced ones. Therefore, we proposed a multi-model deep learning-based automated chest X-ray report generator system designed to assist radiologists in their work. The basic idea of the proposed system is by utilizing multi binary-classification models for detecting multi abnormalities, with each model responsible for detecting one abnormality, in a single image. In this study, we limited the radiology abnormalities detection to only cardiomegaly, lung effusion, and consolidation. The system generates a radiology report by performing the following three steps: image pre-processing, utilizing deep learning models to detect abnormalities, and producing a report. The aim of the image pre-processing step is to standardize the input by scaling it to 128x128 pixels and slicing it into three segments, which covers the upper, lower, and middle parts of the lung. After pre-processing, each corresponding model classifies the image, resulting in a 0 (zero) for no abnormality detected and a 1 (one) for the presence of an abnormality. The prediction outputs of each model are then concatenated to form a 'result code'. The 'result code' is used to construct a report by selecting the appropriate pre-determined sentence for each detected abnormality in the report generation step. The proposed system is expected to reduce the workload of radiologists and increase the accuracy of chest X-ray diagnosis.

Breast cancer is a common cancer for women. Early detection of breast cancer can considerably increase the survival rate of women. This paper mainly focuses on transfer learning process to detect breast cancer. Modified VGG (MVGG), residual network, mobile network is proposed and implemented in this paper. DDSM dataset is used in this paper. Experimental results show that our proposed hybrid transfers learning model (Fusion of MVGG16 and ImageNet) provides an accuracy of 88.3% where the number of epoch is 15. On the other hand, only modified VGG 16 architecture (MVGG 16) provides an accuracy 80.8% and MobileNet provides an accuracy of 77.2%. So, it is clearly stated that the proposed hybrid pre-trained network outperforms well compared to single architecture. This architecture can be considered as an effective tool for the radiologists in order to reduce the false negative and false positive rate. Therefore, the efficiency of mammography analysis will be improved.

Automated radiology report generation offers an effective solution to alleviate radiologists' workload. However, most existing methods focus primarily on single or fixed-view images to model current disease conditions, which limits diagnostic accuracy and overlooks disease progression. Although some approaches utilize longitudinal data to track disease progression, they still rely on single images to analyze current visits. To address these issues, we propose enhanced contrastive learning with Multi-view Longitudinal data to facilitate chest X-ray Report Generation, named MLRG. Specifically, we introduce a multi-view longitudinal contrastive learning method that integrates spatial information from current multi-view images and temporal information from longitudinal data. This method also utilizes the inherent spatiotemporal information of radiology reports to supervise the pre-training of visual and textual representations. Subsequently, we present a tokenized absence encoding technique to flexibly handle missing patient-specific prior knowledge, allowing the model to produce more accurate radiology reports based on available prior knowledge. Extensive experiments on MIMIC-CXR, MIMIC-ABN, and Two-view CXR datasets demonstrate that our MLRG outperforms recent state-of-the-art methods, achieving a 2.3% BLEU-4 improvement on MIMIC-CXR, a 5.5% F1 score improvement on MIMIC-ABN, and a 2.7% F1 RadGraph improvement on Two-view CXR.

A radiology report comprises several sections, including the Findings and Impression of the diagnosis. Automatically generating the Impression from the Findings is crucial for reducing radiologists' workload and improving diagnostic accuracy. Pretrained models that excel in common abstractive summarization problems encounter challenges when applied to specialized medical domains largely due to the complex terminology and the necessity for accurate clinical context. Such tasks in medical domains demand extracting core information, avoiding context shifts, and maintaining proper flow. Misuse of medical terms can lead to drastic clinical errors. To address these issues, we introduce a sequential transfer learning that ensures key content extraction and coherent summarization. Sequential transfer learning often faces challenges like initial parameter decay and knowledge loss, which we resolve with the Fisher matrix regularization. Using MIMIC-CXR and Open-I datasets, our model, CSTRL - Context-driven Sequential TRansfer Learning - achieved state-of-the-art performance, showing 56.2% improvement in BLEU-1, 40.5% in BLEU-2, 84.3% in BLEU-3, 28.9% in ROUGE-1, 41.0% in ROUGE-2 and 26.5% in ROGUE-3 score over benchmark studies. We also analyze factual consistency scores while preserving the medical context. Our code is publicly available at https://github.com/fahmidahossain/Report_Summarization.

Most of the existing chest X-ray datasets include labels from a list of findings without specifying their locations on the radiographs. This limits the development of machine learning algorithms for the detection and localization of chest abnormalities. In this work, we describe a dataset of more than 100,000 chest X-ray scans that were retrospectively collected from two major hospitals in Vietnam. Out of this raw data, we release 18,000 images that were manually annotated by a total of 17 experienced radiologists with 22 local labels of rectangles surrounding abnormalities and 6 global labels of suspected diseases. The released dataset is divided into a training set of 15,000 and a test set of 3,000. Each scan in the training set was independently labeled by 3 radiologists, while each scan in the test set was labeled by the consensus of 5 radiologists. We designed and built a labeling platform for DICOM images to facilitate these annotation procedures. All images are made publicly available (https://www.physionet.org/content/vindr-cxr/1.0.0/) in DICOM format along with the labels of both the training set and the test set.

With the significantly increasing incidence and prevalence of abdominal diseases, there is a need to embrace greater use of new innovations and technology for the diagnosis and treatment of patients. Although deep-learning methods have notably been developed to assist radiologists in diagnosing abdominal diseases, existing models have the restricted ability to segment common lesions in the abdomen due to missing annotations for typical abdominal pathologies in their training datasets. To address the limitation, we introduce MSWAL, the first 3D Multi-class Segmentation of the Whole Abdominal Lesions dataset, which broadens the coverage of various common lesion types, such as gallstones, kidney stones, liver tumors, kidney tumors, pancreatic cancer, liver cysts, and kidney cysts. With CT scans collected from 694 patients (191,417 slices) of different genders across various scanning phases, MSWAL demonstrates strong robustness and generalizability. The transfer learning experiment from MSWAL to two public datasets, LiTS and KiTS, effectively demonstrates consistent improvements, with Dice Similarity Coefficient (DSC) increase of 3.00% for liver tumors and 0.89% for kidney tumors, demonstrating that the comprehensive annotations and diverse lesion types in MSWAL facilitate effective learning across different domains and data distributions. Furthermore, we propose Inception nnU-Net, a novel segmentation framework that effectively integrates an Inception module with the nnU-Net architecture to extract information from different receptive fields, achieving significant enhancement in both voxel-level DSC and region-level F1 compared to the cutting-edge public algorithms on MSWAL. Our dataset will be released after being accepted, and the code is publicly released at https://github.com/tiuxuxsh76075/MSWAL-.

Rationale and Objectives: To develop and validate PARROT (Polyglottal Annotated Radiology Reports for Open Testing), a large, multicentric, open-access dataset of fictional radiology reports spanning multiple languages for testing natural language processing applications in radiology. Materials and Methods: From May to September 2024, radiologists were invited to contribute fictional radiology reports following their standard reporting practices. Contributors provided at least 20 reports with associated metadata including anatomical region, imaging modality, clinical context, and for non-English reports, English translations. All reports were assigned ICD-10 codes. A human vs. AI report differentiation study was conducted with 154 participants (radiologists, healthcare professionals, and non-healthcare professionals) assessing whether reports were human-authored or AI-generated. Results: The dataset comprises 2,658 radiology reports from 76 authors across 21 countries and 13 languages. Reports cover multiple imaging modalities (CT: 36.1%, MRI: 22.8%, radiography: 19.0%, ultrasound: 16.8%) and anatomical regions, with chest (19.9%), abdomen (18.6%), head (17.3%), and pelvis (14.1%) being most prevalent. In the differentiation study, participants achieved 53.9% accuracy (95% CI: 50.7%-57.1%) in distinguishing between human and AI-generated reports, with radiologists performing significantly better (56.9%, 95% CI: 53.3%-60.6%, p<0.05) than other groups. Conclusion: PARROT represents the largest open multilingual radiology report dataset, enabling development and validation of natural language processing applications across linguistic, geographic, and clinical boundaries without privacy constraints.

Polymicrogyria (PMG) is a disorder of cortical organization mainly seen in children, which can be associated with seizures, developmental delay and motor weakness. PMG is typically diagnosed on magnetic resonance imaging (MRI) but some cases can be challenging to detect even for experienced radiologists. In this study, we create an open pediatric MRI dataset (PPMR) with PMG and controls from the Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada. The differences between PMG MRIs and control MRIs are subtle and the true distribution of the features of the disease is unknown. This makes automatic detection of cases of potential PMG in MRI difficult. We propose an anomaly detection method based on a novel center-based deep contrastive metric learning loss function (cDCM) which enables the automatic detection of cases of potential PMG. Additionally, based on our proposed loss function, we customize a deep learning model structure that integrates dilated convolution, squeeze-and-excitation blocks and feature fusion for our PPMR dataset. Despite working with a small and imbalanced dataset our method achieves 92.01% recall at 55.04% precision. This will facilitate a computer aided tool for radiologists to select potential PMG MRIs. To the best of our knowledge, this research is the first to apply machine learning techniques to identify PMG from MRI only.

Advances in artificial intelligence (AI) have achieved expert-level performance in medical imaging applications. Notably, self-supervised vision-language foundation models can detect a broad spectrum of pathologies without relying on explicit training annotations. However, it is crucial to ensure that these AI models do not mirror or amplify human biases, thereby disadvantaging historically marginalized groups such as females or Black patients. The manifestation of such biases could systematically delay essential medical care for certain patient subgroups. In this study, we investigate the algorithmic fairness of state-of-the-art vision-language foundation models in chest X-ray diagnosis across five globally-sourced datasets. Our findings reveal that compared to board-certified radiologists, these foundation models consistently underdiagnose marginalized groups, with even higher rates seen in intersectional subgroups, such as Black female patients. Such demographic biases present over a wide range of pathologies and demographic attributes. Further analysis of the model embedding uncovers its significant encoding of demographic information. Deploying AI systems with these biases in medical imaging can intensify pre-existing care disparities, posing potential challenges to equitable healthcare access and raising ethical questions about their clinical application.

Photon-counting CT (PCCT) provides superior image quality with higher spatial resolution and lower noise compared to conventional energy-integrating CT (EICT), but its limited clinical availability restricts large-scale research and clinical deployment. To bridge this gap, we propose SUMI, a simulated degradation-to-enhancement method that learns to reverse realistic acquisition artifacts in low-quality EICT by leveraging high-quality PCCT as reference. Our central insight is to explicitly model realistic acquisition degradations, transforming PCCT into clinically plausible lower-quality counterparts and learning to invert this process. The simulated degradations were validated for clinical realism by board-certified radiologists, enabling faithful supervision without requiring paired acquisitions at scale. As outcomes of this technical contribution, we: (1) train a latent diffusion model on 1,046 PCCTs, using an autoencoder first pre-trained on both these PCCTs and 405,379 EICTs from 145 hospitals to extract general CT latent features that we release for reuse in other generative medical imaging tasks; (2) construct a large-scale dataset of over 17,316 publicly available EICTs enhanced to PCCT-like quality, with radiologist-validated voxel-wise annotations of airway trees, arteries, veins, lungs, and lobes; and (3) demonstrate substantial improvements: across external data, SUMI outperforms state-of-the-art image translation methods by 15% in SSIM and 20% in PSNR, improves radiologist-rated clinical utility in reader studies, and enhances downstream top-ranking lesion detection performance, increasing sensitivity by up to 15% and F1 score by up to 10%. Our results suggest that emerging imaging advances can be systematically distilled into routine EICT using limited high-quality scans as reference.

Reliable end-to-end clinical report generation has been a longstanding goal of medical ML research. The end goal for this process is to alleviate radiologists' workloads and provide second opinions to clinicians or patients. Thus, a necessary prerequisite for report generation models is a strong general performance and some type of innate grounding capability, to convince clinicians or patients of the veracity of the generated reports. In this paper, we present ASaRG (Automatic Segmentation-assisted Report Generation), an extension of the popular LLaVA architecture that aims to tackle both of these problems. ASaRG proposes to fuse intermediate features and fine-grained segmentation maps created by specialist radiological models into LLaVA's multi-modal projection layer via simple concatenation. With a small number of added parameters, our approach achieves a +0.89\% performance gain (p=0.012) in CE F1 score compared to the LLaVA baseline when using only intermediate features, and +2.77\% performance gain (p<0.001) when adding a combination of intermediate features and fine-grained segmentation maps. Compared with COMG and ORID, two other report generation methods that utilize segmentations, the performance gain amounts to 6.98\% and 6.28\% in F1 score, respectively. ASaRG is not mutually exclusive with other changes made to the LLaVA architecture, potentially allowing our method to be combined with other advances in the field. Finally, the use of an arbitrary number of segmentations as part of the input demonstrably allows tracing elements of the report to the corresponding segmentation maps and verifying the groundedness of assessments. Our code will be made publicly available at a later date.

Breast cancer is a major global health concern, and mammography screening plays a central role in early detection. The large volume of screening examinations creates a substantial workload for radiologists, making accurate and consistent report generation a critical clinical challenge. Existing automated mammography report generation methods primarily focus on direct visual-to-text mapping, while overlooking the structured clinical reasoning process followed by radiologists in real-world practice. To address this limitation, we propose MammoRG, a mammography report generation framework that explicitly simulates the clinical reporting workflow by following the BI-RADS guideline and incorporating prior clinical knowledge to produce diagnostic reports. Specifically, MammoRG adopts a two-stage training framework. In the first stage, the model learns to integrate clinically relevant prior knowledge from a patient's four-view mammograms through classification-based supervision. In the second stage, a terminology-aware supervised fine-tuning strategy is introduced to model mammography-specific clinical terms as atomic semantic units, enabling the generation of high-quality reports with improved clinical consistency. To facilitate clinical efficacy evaluation of generated reports, we further develop MammoRGTool, a dedicated mammography report parsing tool that extracts structured clinical information from free-text reports. Extensive experiments demonstrate that MammoRG consistently outperforms existing methods across multiple clinical efficacy metrics, particularly in diagnosis-related BI-RADS F1, where it surpasses the second-best model by 2.73%, 2.04%, 1.90%, and 3.27% on the internal, external 1, external 2, and VinDr-Mammo datasets, respectively.

We introduce GazeVaLM, a public eye-tracking dataset for studying clinical perception during chest radiograph authenticity assessment. The dataset comprises 960 gaze recordings from 16 expert radiologists interpreting 30 real and 30 synthetic chest X-rays (generated by diffusion based generative AI) under two conditions: diagnostic assessment and real-fake classification (Visual Turing test). For each image-observer pair, we provide raw gaze samples, fixation maps, scanpaths, saliency density maps, structured diagnostic labels, and authenticity judgments. We extend the protocol to 6 state-of-the-art multimodal LLMs, releasing their predicted diagnoses, authenticity labels, and confidence scores under matched conditions - enabling direct human-AI comparison at both decision and uncertainty levels. We further provide analyses of gaze agreement, inter-observer consistency, and benchmarking of radiologists versus LLMs in diagnostic accuracy and authenticity detection. GazeVaLM supports research in gaze modeling, clinical decision-making, human-AI comparison, generative image realism assessment, and uncertainty quantification. By jointly releasing visual attention data, clinical labels, and model predictions, we aim to facilitate reproducible research on how experts and AI systems perceive, interpret, and evaluate medical images. The dataset is available at https://huggingface.co/datasets/davidcwong/GazeVaLM.

Artificial intelligence (AI) shows great potential in assisting radiologists to improve the efficiency and accuracy of medical image interpretation and diagnosis. However, a versatile AI model requires large-scale data and comprehensive annotations, which are often impractical in medical settings. Recent studies leverage radiology reports as a naturally high-quality supervision for medical images, using contrastive language-image pre-training (CLIP) to develop language-informed models for radiological image interpretation. Nonetheless, these approaches typically contrast entire images with reports, neglecting the local associations between imaging regions and report sentences, which may undermine model performance and interoperability. In this paper, we propose a fine-grained vision-language model (fVLM) for anatomy-level CT image interpretation. Specifically, we explicitly match anatomical regions of CT images with corresponding descriptions in radiology reports and perform contrastive pre-training for each anatomy individually. Fine-grained alignment, however, faces considerable false-negative challenges, mainly from the abundance of anatomy-level healthy samples and similarly diseased abnormalities. To tackle this issue, we propose identifying false negatives of both normal and abnormal samples and calibrating contrastive learning from patient-level to disease-aware pairing. We curated the largest CT dataset to date, comprising imaging and report data from 69,086 patients, and conducted a comprehensive evaluation of 54 major and important disease diagnosis tasks across 15 main anatomies. Experimental results demonstrate the substantial potential of fVLM in versatile medical image interpretation. In the zero-shot classification task, we achieved an average AUC of 81.3% on 54 diagnosis tasks, surpassing CLIP and supervised methods by 12.9% and 8.0%, respectively.

The deployment of Large Language Models (LLMs) for structuring clinical data is critically hindered by their tendency to hallucinate facts and their inability to follow domain-specific rules. To address this, we introduce MedPAO, a novel agentic framework that ensures accuracy and verifiable reasoning by grounding its operation in established clinical protocols such as the ABCDEF protocol for CXR analysis. MedPAO decomposes the report structuring task into a transparent process managed by a Plan-Act-Observe (PAO) loop and specialized tools. This protocol-driven method provides a verifiable alternative to opaque, monolithic models. The efficacy of our approach is demonstrated through rigorous evaluation: MedPAO achieves an F1-score of 0.96 on the critical sub-task of concept categorization. Notably, expert radiologists and clinicians rated the final structured outputs with an average score of 4.52 out of 5, indicating a level of reliability that surpasses baseline approaches relying solely on LLM-based foundation models. The code is available at: https://github.com/MiRL-IITM/medpao-agent

There is substantial interest in developing artificial intelligence systems to support radiologists across tasks ranging from segmentation to report generation. Existing computed tomography (CT) foundation models have largely focused on building generalist vision-language systems capable of tasks such as question answering and report generation. However, training reliable vision-language systems requires paired image-text data at a scale that remains unavailable in CT. Moreover, adapting the underlying visual representations to downstream tasks typically requires partial or full backbone fine-tuning, a computationally demanding process inaccessible to many research groups. Instead, foundation models should prioritise learning robust visual representations that enable efficient transfer to new tasks with minimal labelled data and without backbone fine-tuning. We present VoxelFM, a 3D CT foundation model trained with self-distillation using the DINO framework, which learns semantically rich features without language supervision. We evaluated VoxelFM across seven categories of clinically relevant downstream tasks using frozen backbone representations with lightweight probes: classification, regression, survival analysis, instance retrieval, localisation, segmentation, and report generation. VoxelFM matched or outperformed four existing CT foundation models across all task categories. Despite receiving no language supervision during pre-training, VoxelFM surpassed models explicitly trained with language-alignment objectives, including on report generation. Our results indicate that current CT foundation models perform significantly better as feature extractors for lightweight probes rather than as vision encoders for vision-language models. Model weights and training code are publicly available.

Existing text-guided segmentation models in the medical domain cover only a narrow set of anatomical structures and lesions in chest X-rays (CXRs), and most of them assume that the queried target is always present in the image. Instruction-guided lesion segmentation (ILS) was introduced to overcome these limitations by segmenting diverse lesion types from simple user instructions while also recognizing when the queried lesion is absent, and ROSALIA was proposed as the first model for this task. However, the masks produced by ROSALIA remain of limited quality, often carrying scattered noise. Moreover, ROSALIA predicts the mask in a single shot, which differs fundamentally from how radiologists perceive and delineate lesions in practice. A radiologist first surveys the entire thorax, then localizes the approximate region of abnormality, and only then refines the lesion contour. Motivated by this coarse-to-fine, multi-level perception process, we present XFlow, a workflow model for ILS that combines box-based localization with multi-turn point refinement. XFlow detects the lungs, decides whether the queried finding is present in each of them, and prompts a fine-tuned SAM with the lesion box for an initial mask. It then corrects that mask through point prompts until its boundary follows the lesion, leaving every intermediate decision visible. Our experiments show that XFlow achieves the best segmentation quality on both internal and external evaluation. Notably, it surpasses ROSALIA in segmentation quality even when the two are trained on the same lesion annotations. Code and model weights will be made publicly available.

Brain MRI interpretation is a longitudinal clinical reasoning problem: radiologists compare serial studies, integrate information across MRI sequences, localize findings within volumetric anatomy, and translate this evidence into report-grounded assessments. Existing medical VQA and 3D imaging benchmarks capture important parts of this workflow, but often evaluate brain MRI through isolated images, static volumes, or ungrounded report-style answers, thereby obscuring failures in the evidence chain that support clinical validity. We introduce BrainTRACE, a report-grounded benchmark for evaluating whether vision-language models can trace the evidence structure required for longitudinal brain MRI interpretation. BrainTRACE contains 7,273 scored VQA instances derived from 1,778 longitudinal patients, 7,299 MRI studies, and approximately 29k co-registered 3D MRI sequence volumes. The benchmark is organized by five levels of clinical reasoning, from acquisition recognition to case-level synthesis, and by evidence demands covering longitudinal comparison, report-grounded references, multi-sequence integration, and volumetric spatial evidence. BrainTRACE supports rendered inputs compatible with standard VLM interfaces, a 3D-evidence condition, and a decomposed case-reasoning track that audits six steps in a longitudinal evidence chain. Evaluation of 20 VLM configurations shows that current systems can identify isolated visual cues but rarely compose them into grounded longitudinal interpretations. We release the benchmark specification, evaluation lists, scoring implementation, scoring rubrics, and audit-record format to support reproducible progress in brain MRI VLM evaluation.

The learning process for medical residents presents significant challenges, demanding both the ability to interpret complex case reports and the rapid acquisition of accurate medical knowledge from reliable sources. Residents typically study case reports and engage in discussions with peers and mentors, but finding relevant educational materials and evidence to support their learning from these cases is often time-consuming and challenging. To address this, we introduce MedTutor, a novel system designed to augment resident training by automatically generating evidence-based educational content and multiple-choice questions from clinical case reports. MedTutor leverages a Retrieval-Augmented Generation (RAG) pipeline that takes clinical case reports as input and produces targeted educational materials. The system's architecture features a hybrid retrieval mechanism that synergistically queries a local knowledge base of medical textbooks and academic literature (using PubMed, Semantic Scholar APIs) for the latest related research, ensuring the generated content is both foundationally sound and current. The retrieved evidence is filtered and ordered using a state-of-the-art reranking model and then an LLM generates the final long-form output describing the main educational content regarding the case-report. We conduct a rigorous evaluation of the system. First, three radiologists assessed the quality of outputs, finding them to be of high clinical and educational value. Second, we perform a large scale evaluation using an LLM-as-a Judge to understand if LLMs can be used to evaluate the output of the system. Our analysis using correlation between LLMs outputs and human expert judgments reveals a moderate alignment and highlights the continued necessity of expert oversight.

Artificial intelligence (AI) models are increasingly used in the medical domain. However, as medical data is highly sensitive, special precautions to ensure its protection are required. The gold standard for privacy preservation is the introduction of differential privacy (DP) to model training. Prior work indicates that DP has negative implications on model accuracy and fairness, which are unacceptable in medicine and represent a main barrier to the widespread use of privacy-preserving techniques. In this work, we evaluated the effect of privacy-preserving training of AI models regarding accuracy and fairness compared to non-private training. For this, we used two datasets: (1) A large dataset (N=193,311) of high quality clinical chest radiographs, and (2) a dataset (N=1,625) of 3D abdominal computed tomography (CT) images, with the task of classifying the presence of pancreatic ductal adenocarcinoma (PDAC). Both were retrospectively collected and manually labeled by experienced radiologists. We then compared non-private deep convolutional neural networks (CNNs) and privacy-preserving (DP) models with respect to privacy-utility trade-offs measured as area under the receiver-operator-characteristic curve (AUROC), and privacy-fairness trade-offs, measured as Pearson's r or Statistical Parity Difference. We found that, while the privacy-preserving trainings yielded lower accuracy, they did largely not amplify discrimination against age, sex or co-morbidity. Our study shows that -- under the challenging realistic circumstances of a real-life clinical dataset -- the privacy-preserving training of diagnostic deep learning models is possible with excellent diagnostic accuracy and fairness.

Multi-modal data abounds in biomedicine, such as radiology images and reports. Interpreting this data at scale is essential for improving clinical care and accelerating clinical research. Biomedical text with its complex semantics poses additional challenges in vision--language modelling compared to the general domain, and previous work has used insufficiently adapted models that lack domain-specific language understanding. In this paper, we show that principled textual semantic modelling can substantially improve contrastive learning in self-supervised vision--language processing. We release a language model that achieves state-of-the-art results in radiology natural language inference through its improved vocabulary and novel language pretraining objective leveraging semantics and discourse characteristics in radiology reports. Further, we propose a self-supervised joint vision--language approach with a focus on better text modelling. It establishes new state of the art results on a wide range of publicly available benchmarks, in part by leveraging our new domain-specific language model. We release a new dataset with locally-aligned phrase grounding annotations by radiologists to facilitate the study of complex semantic modelling in biomedical vision--language processing. A broad evaluation, including on this new dataset, shows that our contrastive learning approach, aided by textual-semantic modelling, outperforms prior methods in segmentation tasks, despite only using a global-alignment objective.

Magnetic Resonance Imaging (MRI) is a widely-accepted imaging technique for knee injury analysis. Its advantage of capturing knee structure in three dimensions makes it the ideal tool for radiologists to locate potential tears in the knee. In order to better confront the ever growing workload of musculoskeletal (MSK) radiologists, automated tools for patients' triage are becoming a real need, reducing delays in the reading of pathological cases. In this work, we present the Efficiently-Layered Network (ELNet), a convolutional neural network (CNN) architecture optimized for the task of initial knee MRI diagnosis for triage. Unlike past approaches, we train ELNet from scratch instead of using a transfer-learning approach. The proposed method is validated quantitatively and qualitatively, and compares favorably against state-of-the-art MRNet while using a single imaging stack (axial or coronal) as input. Additionally, we demonstrate our model's capability to locate tears in the knee despite the absence of localization information during training. Lastly, the proposed model is extremely lightweight (< 1MB) and therefore easy to train and deploy in real clinical settings. The code for our model is provided at: https://github.com/mxtsai/ELNet.

Coronavirus disease 2019 (Covid-19) is highly contagious with limited treatment options. Early and accurate diagnosis of Covid-19 is crucial in reducing the spread of the disease and its accompanied mortality. Currently, detection by reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard of outpatient and inpatient detection of Covid-19. RT-PCR is a rapid method, however, its accuracy in detection is only ~70-75%. Another approved strategy is computed tomography (CT) imaging. CT imaging has a much higher sensitivity of ~80-98%, but similar accuracy of 70%. To enhance the accuracy of CT imaging detection, we developed an open-source set of algorithms called CovidCTNet that successfully differentiates Covid-19 from community-acquired pneumonia (CAP) and other lung diseases. CovidCTNet increases the accuracy of CT imaging detection to 90% compared to radiologists (70%). The model is designed to work with heterogeneous and small sample sizes independent of the CT imaging hardware. In order to facilitate the detection of Covid-19 globally and assist radiologists and physicians in the screening process, we are releasing all algorithms and parametric details in an open-source format. Open-source sharing of our CovidCTNet enables developers to rapidly improve and optimize services, while preserving user privacy and data ownership.

Language-supervised pre-training has proven to be a valuable method for extracting semantically meaningful features from images, serving as a foundational element in multimodal systems within the computer vision and medical imaging domains. However, resulting features are limited by the information contained within the text. This is particularly problematic in medical imaging, where radiologists' written findings focus on specific observations; a challenge compounded by the scarcity of paired imaging-text data due to concerns over leakage of personal health information. In this work, we fundamentally challenge the prevailing reliance on language supervision for learning general purpose biomedical imaging encoders. We introduce RAD-DINO, a biomedical image encoder pre-trained solely on unimodal biomedical imaging data that obtains similar or greater performance than state-of-the-art biomedical language supervised models on a diverse range of benchmarks. Specifically, the quality of learned representations is evaluated on standard imaging tasks (classification and semantic segmentation), and a vision-language alignment task (text report generation from images). To further demonstrate the drawback of language supervision, we show that features from RAD-DINO correlate with other medical records (e.g., sex or age) better than language-supervised models, which are generally not mentioned in radiology reports. Finally, we conduct a series of ablations determining the factors in RAD-DINO's performance; notably, we observe that RAD-DINO's downstream performance scales well with the quantity and diversity of training data, demonstrating that image-only supervision is a scalable approach for training a foundational biomedical image encoder.

Accurate segmentation of tumors in PET/CT images is important in computer-aided diagnosis and treatment of cancer. The key issue of such a segmentation problem lies in the effective integration of complementary information from PET and CT images. However, the quality of PET and CT images varies widely in clinical settings, which leads to uncertainty in the modality information extracted by networks. To take the uncertainty into account in multi-modal information fusion, this paper proposes a novel Multi-modal Evidential Fusion Network (MEFN) comprising a Cross-Modal Feature Learning (CFL) module and a Multi-modal Trusted Fusion (MTF) module. The CFL module reduces the domain gap upon modality conversion and highlights common tumor features, thereby alleviating the needs of the segmentation module to handle modality specificity. The MTF module utilizes mutual attention mechanisms and an uncertainty calibrator to fuse modality features based on modality uncertainty and then fuse the segmentation results under the guidance of Dempster-Shafer Theory. Besides, a new uncertainty perceptual loss is introduced to force the model focusing on uncertain features and hence improve its ability to extract trusted modality information. Extensive comparative experiments are conducted on two publicly available PET/CT datasets to evaluate the performance of our proposed method whose results demonstrate that our MEFN significantly outperforms state-of-the-art methods with improvements of 2.15% and 3.23% in DSC scores on the AutoPET dataset and the Hecktor dataset, respectively. More importantly, our model can provide radiologists with credible uncertainty of the segmentation results for their decision in accepting or rejecting the automatic segmentation results, which is particularly important for clinical applications. Our code will be available at https://github.com/QPaws/MEFN.

Motion artefacts in magnetic resonance brain images can have a strong impact on diagnostic confidence. The assessment of MR image quality is fundamental before proceeding with the clinical diagnosis. Motion artefacts can alter the delineation of structures such as the brain, lesions or tumours and may require a repeat scan. Otherwise, an inaccurate (e.g. correct pathology but wrong severity) or incorrect diagnosis (e.g. wrong pathology) may occur. "Image quality assessment" as a fast, automated step right after scanning can assist in deciding if the acquired images are diagnostically sufficient. An automated image quality assessment based on the structural similarity index (SSIM) regression through a residual neural network is proposed in this work. Additionally, a classification into different groups - by subdividing with SSIM ranges - is evaluated. Importantly, this method predicts SSIM values of an input image in the absence of a reference ground truth image. The networks were able to detect motion artefacts, and the best performance for the regression and classification task has always been achieved with ResNet-18 with contrast augmentation. The mean and standard deviation of residuals' distribution were mu=-0.0009 and sigma=0.0139, respectively. Whilst for the classification task in 3, 5 and 10 classes, the best accuracies were 97, 95 and 89\%, respectively. The results show that the proposed method could be a tool for supporting neuro-radiologists and radiographers in evaluating image quality quickly.

Since the release of the original CheXpert paper five years ago, CheXpert has become one of the most widely used and cited clinical AI datasets. The emergence of vision language models has sparked an increase in demands for sharing reports linked to CheXpert images, along with a growing interest among AI fairness researchers in obtaining demographic data. To address this, CheXpert Plus serves as a new collection of radiology data sources, made publicly available to enhance the scaling, performance, robustness, and fairness of models for all subsequent machine learning tasks in the field of radiology. CheXpert Plus is the largest text dataset publicly released in radiology, with a total of 36 million text tokens, including 13 million impression tokens. To the best of our knowledge, it represents the largest text de-identification effort in radiology, with almost 1 million PHI spans anonymized. It is only the second time that a large-scale English paired dataset has been released in radiology, thereby enabling, for the first time, cross-institution training at scale. All reports are paired with high-quality images in DICOM format, along with numerous image and patient metadata covering various clinical and socio-economic groups, as well as many pathology labels and RadGraph annotations. We hope this dataset will boost research for AI models that can further assist radiologists and help improve medical care. Data is available at the following URL: https://stanfordaimi.azurewebsites.net/datasets/5158c524-d3ab-4e02-96e9-6ee9efc110a1 Models are available at the following URL: https://github.com/Stanford-AIMI/chexpert-plus

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

Medical eye-tracking data is an important information source for understanding how radiologists visually interpret medical images. This information not only improves the accuracy of deep learning models for X-ray analysis but also their interpretability, enhancing transparency in decision-making. However, the current eye-tracking data is dispersed, unprocessed, and ambiguous, making it difficult to derive meaningful insights. Therefore, there is a need to create a new dataset with more focus and purposeful eyetracking data, improving its utility for diagnostic applications. In this work, we propose a refinement method inspired by the target-present visual search challenge: there is a specific finding and fixations are guided to locate it. After refining the existing eye-tracking datasets, we transform them into a curated visual search dataset, called GazeSearch, specifically for radiology findings, where each fixation sequence is purposefully aligned to the task of locating a particular finding. Subsequently, we introduce a scan path prediction baseline, called ChestSearch, specifically tailored to GazeSearch. Finally, we employ the newly introduced GazeSearch as a benchmark to evaluate the performance of current state-of-the-art methods, offering a comprehensive assessment for visual search in the medical imaging domain. Code is available at https://github.com/UARK-AICV/GazeSearch.

In recent years, automated radiology report generation has experienced significant growth. This paper introduces MRScore, an automatic evaluation metric tailored for radiology report generation by leveraging Large Language Models (LLMs). Conventional NLG (natural language generation) metrics like BLEU are inadequate for accurately assessing the generated radiology reports, as systematically demonstrated by our observations within this paper. To address this challenge, we collaborated with radiologists to develop a framework that guides LLMs for radiology report evaluation, ensuring alignment with human analysis. Our framework includes two key components: i) utilizing GPT to generate large amounts of training data, i.e., reports with different qualities, and ii) pairing GPT-generated reports as accepted and rejected samples and training LLMs to produce MRScore as the model reward. Our experiments demonstrate MRScore's higher correlation with human judgments and superior performance in model selection compared to traditional metrics. Our code and datasets will be available on GitHub.

The analysis of 3D medical images is crucial for modern healthcare, yet traditional task-specific models are becoming increasingly inadequate due to limited generalizability across diverse clinical scenarios. Multimodal large language models (MLLMs) offer a promising solution to these challenges. However, existing MLLMs have limitations in fully leveraging the rich, hierarchical information embedded in 3D medical images. Inspired by clinical practice, where radiologists focus on both 3D spatial structure and 2D planar content, we propose Med-2E3, a novel MLLM for 3D medical image analysis that integrates 3D and 2D encoders. To aggregate 2D features more effectively, we design a Text-Guided Inter-Slice (TG-IS) scoring module, which scores the attention of each 2D slice based on slice contents and task instructions. To the best of our knowledge, Med-2E3 is the first MLLM to integrate both 3D and 2D features for 3D medical image analysis. Experiments on a large-scale, open-source 3D medical multimodal benchmark demonstrate that Med-2E3 exhibits task-specific attention distribution and significantly outperforms current state-of-the-art models, with a 14% improvement in report generation and a 5% gain in medical visual question answering (VQA), highlighting the model's potential in addressing complex multimodal clinical tasks. The code will be released upon acceptance.

Early tumor detection save lives. Each year, more than 300 million computed tomography (CT) scans are performed worldwide, offering a vast opportunity for effective cancer screening. However, detecting small or early-stage tumors on these CT scans remains challenging, even for experts. Artificial intelligence (AI) models can assist by highlighting suspicious regions, but training such models typically requires extensive tumor masks--detailed, voxel-wise outlines of tumors manually drawn by radiologists. Drawing these masks is costly, requiring years of effort and millions of dollars. In contrast, nearly every CT scan in clinical practice is already accompanied by medical reports describing the tumor's size, number, appearance, and sometimes, pathology results--information that is rich, abundant, and often underutilized for AI training. We introduce R-Super, which trains AI to segment tumors that match their descriptions in medical reports. This approach scales AI training with large collections of readily available medical reports, substantially reducing the need for manually drawn tumor masks. When trained on 101,654 reports, AI models achieved performance comparable to those trained on 723 masks. Combining reports and masks further improved sensitivity by +13% and specificity by +8%, surpassing radiologists in detecting five of the seven tumor types. Notably, R-Super enabled segmentation of tumors in the spleen, gallbladder, prostate, bladder, uterus, and esophagus, for which no public masks or AI models previously existed. This study challenges the long-held belief that large-scale, labor-intensive tumor mask creation is indispensable, establishing a scalable and accessible path toward early detection across diverse tumor types. We plan to release our trained models, code, and dataset at https://github.com/MrGiovanni/R-Super

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists' workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT's hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.

An expansion of aberrant brain cells is referred to as a brain tumor. The brain's architecture is extremely intricate, with several regions controlling various nervous system processes. Any portion of the brain or skull can develop a brain tumor, including the brain's protective coating, the base of the skull, the brainstem, the sinuses, the nasal cavity, and many other places. Over the past ten years, numerous developments in the field of computer-aided brain tumor diagnosis have been made. Recently, instance segmentation has attracted a lot of interest in numerous computer vision applications. It seeks to assign various IDs to various scene objects, even if they are members of the same class. Typically, a two-stage pipeline is used to perform instance segmentation. This study shows brain cancer segmentation using YOLOv5. Yolo takes dataset as picture format and corresponding text file. You Only Look Once (YOLO) is a viral and widely used algorithm. YOLO is famous for its object recognition properties. You Only Look Once (YOLO) is a popular algorithm that has gone viral. YOLO is well known for its ability to identify objects. YOLO V2, V3, V4, and V5 are some of the YOLO latest versions that experts have published in recent years. Early brain tumor detection is one of the most important jobs that neurologists and radiologists have. However, it can be difficult and error-prone to manually identify and segment brain tumors from Magnetic Resonance Imaging (MRI) data. For making an early diagnosis of the condition, an automated brain tumor detection system is necessary. The model of the research paper has three classes. They are respectively Meningioma, Pituitary, Glioma. The results show that, our model achieves competitive accuracy, in terms of runtime usage of M2 10 core GPU.

Chest X-ray report generation (CXR-RG) has the potential to substantially alleviate radiologists' workload. However, conventional autoregressive vision--language models (VLMs) suffer from high inference latency due to sequential token decoding. Diffusion-based models offer a promising alternative through parallel generation, but they still require multiple denoising iterations. Compressing multi-step denoising to a single step could further reduce latency, but often degrades textual coherence due to the mean-field bias introduced by token-factorized denoisers. To address this challenge, we propose ECHO, an efficient diffusion-based VLM (dVLM) for chest X-ray report generation. ECHO enables stable one-step-per-block inference via a novel Direct Conditional Distillation (DCD) framework, which mitigates the mean-field limitation by constructing unfactorized supervision from on-policy diffusion trajectories to encode joint token dependencies. In addition, we introduce a Response-Asymmetric Diffusion (RAD) training strategy that further improves training efficiency while maintaining model effectiveness. Extensive experiments demonstrate that ECHO surpasses state-of-the-art autoregressive methods, improving RaTE and SemScore by 64.33\% and 60.58\% respectively, while achieving an 8times inference speedup without compromising clinical accuracy.

Eye-tracking analysis plays a vital role in medical imaging, providing key insights into how radiologists visually interpret and diagnose clinical cases. In this work, we first analyze radiologists' attention and agreement by measuring the distribution of various eye-movement patterns, including saccades direction, amplitude, and their joint distribution. These metrics help uncover patterns in attention allocation and diagnostic strategies. Furthermore, we investigate whether and how doctors' gaze behavior shifts when viewing authentic (Real) versus deep-learning-generated (Fake) images. To achieve this, we examine fixation bias maps, focusing on first, last, short, and longest fixations independently, along with detailed saccades patterns, to quantify differences in gaze distribution and visual saliency between authentic and synthetic images.

Neuroimaging is a ubiquitous tool for evaluating patients with neurological diseases. The global demand for magnetic resonance imaging (MRI) studies has risen steadily, placing significant strain on health systems, prolonging turnaround times, and intensifying physician burnout. These challenges disproportionately impact patients in low-resource and rural settings. Here, we utilized a large academic health system as a data engine to develop Prima, the first vision language model (VLM) serving as an AI foundation for neuroimaging that supports real-world, clinical MRI studies as input. Trained on over 220,000 MRI studies, Prima uses a hierarchical vision architecture that provides general and transferable MRI features. Prima was tested in a 1-year health system-wide study that included 30K MRI studies. Across 52 radiologic diagnoses from the major neurologic disorders, including neoplastic, inflammatory, infectious, and developmental lesions, Prima achieved a mean diagnostic area under the ROC curve of 92.0, outperforming other state-of-the-art general and medical AI models. Prima offers explainable differential diagnoses, worklist priority for radiologists, and clinical referral recommendations across diverse patient demographics and MRI systems. Prima demonstrates algorithmic fairness across sensitive groups and can help mitigate health system biases, such as prolonged turnaround times for low-resource populations. These findings highlight the transformative potential of health system-scale VLMs and Prima's role in advancing AI-driven healthcare.

Multi-cancer segmentation in computed tomography (CT) is fundamentally limited by the scarcity of tumor masks across different organs. We present Merlin Plus, the first large-scale CT dataset with radiologist-created tumor masks across 9 organs. Merlin Plus extends the Merlin dataset by adding 1,153 per-voxel tumor masks and longitudinal metadata. To create these tumor masks, we developed a report-based active-learning framework in which radiology reports identify tumor cases for annotation and support training of a tumor segmentation model. The model generates initial masks, which radiologists review and correct to produce the final masks, reducing annotation burden while maintaining high-quality annotations. Besides tumor masks, the longitudinal metadata in Merlin Plus enables temporal modeling of cancer progression. By directly addressing the major bottleneck of limited multi-cancer segmentation masks, Merlin Plus supports scalable multi-organ cancer detection, segmentation, and longitudinal analysis in CT. Dataset is available at: https://github.com/MrGiovanni/MerlinPlus

Chest X-ray (CXR) reporting follows a region-based clinical workflow in which radiologists inspect anatomical regions and integrate localized findings into a final report. However, existing resources for CXR report generation provide these supervision signals in fragmented forms. We introduce MMRad-22K, a dataset that organizes regional textual observations, anatomical grounding coordinates, localized image evidence, and report targets into structured multimodal evidence units for CXR report generation. To motivate this formulation, we first compare different evidence formats for report generation and find that structured multimodal evidence is generally more useful than text-only or bounding box-based evidence. We then adapt a unified LVLM backbone using MMRad-22K and show that adaptation with multimodal evidence outperforms both textual-evidence adaptation and end-to-end adaptation on language and clinically oriented metrics. Under the same evaluation protocol, the adapted model also reaches a performance level comparable to several open-source LVLM references. Together, these results support MMRad-22K as a practical structured multimodal resource for training and evaluating CXR report generation aligned with clinical reading workflows.

Automated radiology report generation for multi-sequence brain MRI holds strong promise for alleviating radiologists' workload, yet it remains a demanding problem: brain MRI studies are inherently volumetric, each pulse sequence carries complementary diagnostic information, and annotated data are critically scarce for low-resource clinical languages. Existing brain MRI-report resources are still dominated by English reports, translated clinical text, or datasets adapted from task-specific imaging benchmarks, leaving routine low-resource clinical reporting and heterogeneous multi-sequence MRI protocols insufficiently represented. To bridge this gap, we introduce ViBMR, to the best of our knowledge, the first large-scale multi-sequence brain MRI dataset paired with routine Vietnamese clinical reports, comprising 3,649 patients and 11,875 MRI series across T1, T2, FLAIR, and contrast-enhanced T1 sequences. Building on ViBMR, we establish a comprehensive evaluation setup for brain MRI report generation, covering representative medical vision-language models, multi-sequence inputs, and feature aggregation strategies. The results provide key insights into dataset characteristics and model behavior, while demonstrating the necessity of native low-resource clinical datasets for reliable Vietnamese-origin brain MRI report generation. Our dataset and baseline models will be released for non-commercial research.

Lung nodules can be an alarming precursor to potential lung cancer. Missed nodule detections during chest radiograph analysis remains a common challenge among thoracic radiologists. In this work, we present a multi-task lung nodule detection algorithm for chest radiograph analysis. Unlike past approaches, our algorithm predicts a global-level label indicating nodule presence along with local-level labels predicting nodule locations using a Dual Head Network (DHN). We demonstrate the favorable nodule detection performance that our multi-task formulation yields in comparison to conventional methods. In addition, we introduce a novel Dual Head Augmentation (DHA) strategy tailored for DHN, and we demonstrate its significance in further enhancing global and local nodule predictions.

Instance level detection and segmentation of thoracic diseases or abnormalities are crucial for automatic diagnosis in chest X-ray images. Leveraging on constant structure and disease relations extracted from domain knowledge, we propose a structure-aware relation network (SAR-Net) extending Mask R-CNN. The SAR-Net consists of three relation modules: 1. the anatomical structure relation module encoding spatial relations between diseases and anatomical parts. 2. the contextual relation module aggregating clues based on query-key pair of disease RoI and lung fields. 3. the disease relation module propagating co-occurrence and causal relations into disease proposals. Towards making a practical system, we also provide ChestX-Det, a chest X-Ray dataset with instance-level annotations (boxes and masks). ChestX-Det is a subset of the public dataset NIH ChestX-ray14. It contains ~3500 images of 13 common disease categories labeled by three board-certified radiologists. We evaluate our SAR-Net on it and another dataset DR-Private. Experimental results show that it can enhance the strong baseline of Mask R-CNN with significant improvements. The ChestX-Det is released at https://github.com/Deepwise-AILab/ChestX-Det-Dataset.

Segmentation of the coronary artery is an important task for the quantitative analysis of coronary computed tomography angiography (CCTA) images and is being stimulated by the field of deep learning. However, the complex structures with tiny and narrow branches of the coronary artery bring it a great challenge. Coupled with the medical image limitations of low resolution and poor contrast, fragmentations of segmented vessels frequently occur in the prediction. Therefore, a geometry-based cascaded segmentation method is proposed for the coronary artery, which has the following innovations: 1) Integrating geometric deformation networks, we design a cascaded network for segmenting the coronary artery and vectorizing results. The generated meshes of the coronary artery are continuous and accurate for twisted and sophisticated coronary artery structures, without fragmentations. 2) Different from mesh annotations generated by the traditional marching cube method from voxel-based labels, a finer vectorized mesh of the coronary artery is reconstructed with the regularized morphology. The novel mesh annotation benefits the geometry-based segmentation network, avoiding bifurcation adhesion and point cloud dispersion in intricate branches. 3) A dataset named CCA-200 is collected, consisting of 200 CCTA images with coronary artery disease. The ground truths of 200 cases are coronary internal diameter annotations by professional radiologists. Extensive experiments verify our method on our collected dataset CCA-200 and public ASOCA dataset, with a Dice of 0.778 on CCA-200 and 0.895 on ASOCA, showing superior results. Especially, our geometry-based model generates an accurate, intact and smooth coronary artery, devoid of any fragmentations of segmented vessels.

The automated generation of imaging reports proves invaluable in alleviating the workload of radiologists. A clinically applicable reports generation algorithm should demonstrate its effectiveness in producing reports that accurately describe radiology findings and attend to patient-specific indications. In this paper, we introduce a novel method, Structural Entities extraction and patient indications Incorporation (SEI) for chest X-ray report generation. Specifically, we employ a structural entities extraction (SEE) approach to eliminate presentation-style vocabulary in reports and improve the quality of factual entity sequences. This reduces the noise in the following cross-modal alignment module by aligning X-ray images with factual entity sequences in reports, thereby enhancing the precision of cross-modal alignment and further aiding the model in gradient-free retrieval of similar historical cases. Subsequently, we propose a cross-modal fusion network to integrate information from X-ray images, similar historical cases, and patient-specific indications. This process allows the text decoder to attend to discriminative features of X-ray images, assimilate historical diagnostic information from similar cases, and understand the examination intention of patients. This, in turn, assists in triggering the text decoder to produce high-quality reports. Experiments conducted on MIMIC-CXR validate the superiority of SEI over state-of-the-art approaches on both natural language generation and clinical efficacy metrics.

Medical imaging plays a crucial role in diagnosis, with radiology reports serving as vital documentation. Automating report generation has emerged as a critical need to alleviate the workload of radiologists. While machine learning has facilitated report generation for 2D medical imaging, extending this to 3D has been unexplored due to computational complexity and data scarcity. We introduce the first method to generate radiology reports for 3D medical imaging, specifically targeting chest CT volumes. Given the absence of comparable methods, we establish a baseline using an advanced 3D vision encoder in medical imaging to demonstrate our method's effectiveness, which leverages a novel auto-regressive causal transformer. Furthermore, recognizing the benefits of leveraging information from previous visits, we augment CT2Rep with a cross-attention-based multi-modal fusion module and hierarchical memory, enabling the incorporation of longitudinal multimodal data. Access our code at https://github.com/ibrahimethemhamamci/CT2Rep

Medical Image Quality Assessment (IQA) serves as the first-mile safety gate for clinical AI, yet existing approaches remain constrained by scalar, score-based metrics and fail to reflect the descriptive, human-like reasoning process central to expert evaluation. To address this gap, we introduce MedQ-Bench, a comprehensive benchmark that establishes a perception-reasoning paradigm for language-based evaluation of medical image quality with Multi-modal Large Language Models (MLLMs). MedQ-Bench defines two complementary tasks: (1) MedQ-Perception, which probes low-level perceptual capability via human-curated questions on fundamental visual attributes; and (2) MedQ-Reasoning, encompassing both no-reference and comparison reasoning tasks, aligning model evaluation with human-like reasoning on image quality. The benchmark spans five imaging modalities and over forty quality attributes, totaling 2,600 perceptual queries and 708 reasoning assessments, covering diverse image sources including authentic clinical acquisitions, images with simulated degradations via physics-based reconstructions, and AI-generated images. To evaluate reasoning ability, we propose a multi-dimensional judging protocol that assesses model outputs along four complementary axes. We further conduct rigorous human-AI alignment validation by comparing LLM-based judgement with radiologists. Our evaluation of 14 state-of-the-art MLLMs demonstrates that models exhibit preliminary but unstable perceptual and reasoning skills, with insufficient accuracy for reliable clinical use. These findings highlight the need for targeted optimization of MLLMs in medical IQA. We hope that MedQ-Bench will catalyze further exploration and unlock the untapped potential of MLLMs for medical image quality evaluation.

Medical imaging is frequently used in clinical practice and trials for diagnosis and treatment. Writing imaging reports is time-consuming and can be error-prone for inexperienced radiologists. Therefore, automatically generating radiology reports is highly desired to lighten the workload of radiologists and accordingly promote clinical automation, which is an essential task to apply artificial intelligence to the medical domain. In this paper, we propose to generate radiology reports with memory-driven Transformer, where a relational memory is designed to record key information of the generation process and a memory-driven conditional layer normalization is applied to incorporating the memory into the decoder of Transformer. Experimental results on two prevailing radiology report datasets, IU X-Ray and MIMIC-CXR, show that our proposed approach outperforms previous models with respect to both language generation metrics and clinical evaluations. Particularly, this is the first work reporting the generation results on MIMIC-CXR to the best of our knowledge. Further analyses also demonstrate that our approach is able to generate long reports with necessary medical terms as well as meaningful image-text attention mappings.

Automated radiology report generation holds immense potential to alleviate the heavy workload of radiologists. Despite the formidable vision-language capabilities of recent Multimodal Large Language Models (MLLMs), their clinical deployment is severely constrained by inherent limitations: their "black-box" decision-making renders the generated reports untraceable due to the lack of explicit visual evidence to support the diagnosis, and they struggle to access external domain knowledge. To address these challenges, we propose the Evidence-driven Radiology Report Generation Agent (EviAgent). Unlike opaque end-to-end paradigms, EviAgent coordinates a transparent reasoning trajectory by breaking down the complex generation process into granular operational units. We integrate multi-dimensional visual experts and retrieval mechanisms as external support modules, endowing the system with explicit visual evidence and high-quality clinical priors. Extensive experiments on MIMIC-CXR, CheXpert Plus, and IU-Xray datasets demonstrate that EviAgent outperforms both large-scale generalist models and specialized medical models, providing a robust and trustworthy solution for automated radiology report generation.

We present a labeled large-scale, high resolution chest x-ray dataset for the automated exploration of medical images along with their associated reports. This dataset includes more than 160,000 images obtained from 67,000 patients that were interpreted and reported by radiologists at Hospital San Juan Hospital (Spain) from 2009 to 2017, covering six different position views and additional information on image acquisition and patient demography. The reports were labeled with 174 different radiographic findings, 19 differential diagnoses and 104 anatomic locations organized as a hierarchical taxonomy and mapped onto standard Unified Medical Language System (UMLS) terminology. Of these reports, 27% were manually annotated by trained physicians and the remaining set was labeled using a supervised method based on a recurrent neural network with attention mechanisms. The labels generated were then validated in an independent test set achieving a 0.93 Micro-F1 score. To the best of our knowledge, this is one of the largest public chest x-ray database suitable for training supervised models concerning radiographs, and the first to contain radiographic reports in Spanish. The PadChest dataset can be downloaded from http://bimcv.cipf.es/bimcv-projects/padchest/.

In clinical radiology reports, doctors capture important information about the patient's health status. They convey their observations from raw medical imaging data about the inner structures of a patient. As such, formulating reports requires medical experts to possess wide-ranging knowledge about anatomical regions with their normal, healthy appearance as well as the ability to recognize abnormalities. This explicit grasp on both the patient's anatomy and their appearance is missing in current medical image-processing systems as annotations are especially difficult to gather. This renders the models to be narrow experts e.g. for identifying specific diseases. In this work, we recover this missing link by adding human anatomy into the mix and enable the association of content in medical reports to their occurrence in associated imagery (medical phrase grounding). To exploit anatomical structures in this scenario, we present a sophisticated automatic pipeline to gather and integrate human bodily structures from computed tomography datasets, which we incorporate in our PAXRay: A Projected dataset for the segmentation of Anatomical structures in X-Ray data. Our evaluation shows that methods that take advantage of anatomical information benefit heavily in visually grounding radiologists' findings, as our anatomical segmentations allow for up to absolute 50% better grounding results on the OpenI dataset as compared to commonly used region proposals. The PAXRay dataset is available at https://constantinseibold.github.io/paxray/.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

The pandemic resulted in vast repositories of unstructured data, including radiology reports, due to increased medical examinations. Previous research on automated diagnosis of COVID-19 primarily focuses on X-ray images, despite their lower precision compared to computed tomography (CT) scans. In this work, we leverage unstructured data from a hospital and harness the fine-grained details offered by CT scans to perform zero-shot multi-label classification based on contrastive visual language learning. In collaboration with human experts, we investigate the effectiveness of multiple zero-shot models that aid radiologists in detecting pulmonary embolisms and identifying intricate lung details like ground glass opacities and consolidations. Our empirical analysis provides an overview of the possible solutions to target such fine-grained tasks, so far overlooked in the medical multimodal pretraining literature. Our investigation promises future advancements in the medical image analysis community by addressing some challenges associated with unstructured data and fine-grained multi-label classification.

Purpose: Automating tasks such as lung tumor localization and segmentation in radiological images can free valuable time for radiologists and other clinical personnel. Convolutional neural networks may be suited for such tasks, but require substantial amounts of labeled data to train. Obtaining labeled data is a challenge, especially in the medical domain. Methods: This paper investigates the use of a teacher-student design to utilize datasets with different types of supervision to train an automatic model performing pulmonary tumor segmentation on computed tomography images. The framework consists of two models: the student that performs end-to-end automatic tumor segmentation and the teacher that supplies the student additional pseudo-annotated data during training. Results: Using only a small proportion of semantically labeled data and a large number of bounding box annotated data, we achieved competitive performance using a teacher-student design. Models trained on larger amounts of semantic annotations did not perform better than those trained on teacher-annotated data. Conclusions: Our results demonstrate the potential of utilizing teacher-student designs to reduce the annotation load, as less supervised annotation schemes may be performed, without any real degradation in segmentation accuracy.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

The integration of Computer-Assisted Diagnosis (CAD) with Large Language Models (LLMs) holds great potential in clinical applications, specifically in the roles of virtual family doctors and clinic assistants. However, current works in this field are plagued by limitations, specifically a restricted scope of applicable image domains and the provision of unreliable medical advice. This restricts their overall processing capabilities. Furthermore, the mismatch in writing style between LLMs and radiologists undermines their practical usefulness. To tackle these challenges, we introduce ChatCAD+, which is designed to be universal and reliable. It is capable of handling medical images from diverse domains and leveraging up-to-date information from reputable medical websites to provide reliable medical advice. Additionally, it incorporates a template retrieval system that improves report generation performance via exemplar reports. This approach ensures greater consistency with the expertise of human professionals. The source code is available at https://github.com/zhaozh10/ChatCAD.

Multi-modality magnetic resonance imaging data with various sequences facilitate the early diagnosis, tumor segmentation, and disease staging in the management of nasopharyngeal carcinoma (NPC). The lack of publicly available, comprehensive datasets limits advancements in diagnosis, treatment planning, and the development of machine learning algorithms for NPC. Addressing this critical need, we introduce the first comprehensive NPC MRI dataset, encompassing MR axial imaging of 277 primary NPC patients. This dataset includes T1-weighted, T2-weighted, and contrast-enhanced T1-weighted sequences, totaling 831 scans. In addition to the corresponding clinical data, manually annotated and labeled segmentations by experienced radiologists offer high-quality data resources from untreated primary NPC.

Radiology report generation (RRG) aims to automatically generate free-text descriptions from clinical radiographs, e.g., chest X-Ray images. RRG plays an essential role in promoting clinical automation and presents significant help to provide practical assistance for inexperienced doctors and alleviate radiologists' workloads. Therefore, consider these meaningful potentials, research on RRG is experiencing explosive growth in the past half-decade, especially with the rapid development of deep learning approaches. Existing studies perform RRG from the perspective of enhancing different modalities, provide insights on optimizing the report generation process with elaborated features from both visual and textual information, and further facilitate RRG with the cross-modal interactions among them. In this paper, we present a comprehensive review of deep learning-based RRG from various perspectives. Specifically, we firstly cover pivotal RRG approaches based on the task-specific features of radiographs, reports, and the cross-modal relations between them, and then illustrate the benchmark datasets conventionally used for this task with evaluation metrics, subsequently analyze the performance of different approaches and finally offer our summary on the challenges and the trends in future directions. Overall, the goal of this paper is to serve as a tool for understanding existing literature and inspiring potential valuable research in the field of RRG.

Purpose: In radiology, large language models (LLMs), including ChatGPT, have recently gained attention, and their utility is being rapidly evaluated. However, concerns have emerged regarding their reliability in clinical applications due to limitations such as hallucinations and insufficient referencing. To address these issues, we focus on the latest technology, retrieval-augmented generation (RAG), which enables LLMs to reference reliable external knowledge (REK). Specifically, this study examines the utility and reliability of a recently released RAG-equipped LLM (RAG-LLM), NotebookLM, for staging lung cancer. Materials and methods: We summarized the current lung cancer staging guideline in Japan and provided this as REK to NotebookLM. We then tasked NotebookLM with staging 100 fictional lung cancer cases based on CT findings and evaluated its accuracy. For comparison, we performed the same task using a gold-standard LLM, GPT-4 Omni (GPT-4o), both with and without the REK. Results: NotebookLM achieved 86% diagnostic accuracy in the lung cancer staging experiment, outperforming GPT-4o, which recorded 39% accuracy with the REK and 25% without it. Moreover, NotebookLM demonstrated 95% accuracy in searching reference locations within the REK. Conclusion: NotebookLM successfully performed lung cancer staging by utilizing the REK, demonstrating superior performance compared to GPT-4o. Additionally, it provided highly accurate reference locations within the REK, allowing radiologists to efficiently evaluate the reliability of NotebookLM's responses and detect possible hallucinations. Overall, this study highlights the potential of NotebookLM, a RAG-LLM, in image diagnosis.

Diffusion-weighted MRI (DWI) is essential for stroke diagnosis, treatment decisions, and prognosis. However, image and disease variability hinder the development of generalizable AI algorithms with clinical value. We address this gap by presenting a novel ensemble algorithm derived from the 2022 Ischemic Stroke Lesion Segmentation (ISLES) challenge. ISLES'22 provided 400 patient scans with ischemic stroke from various medical centers, facilitating the development of a wide range of cutting-edge segmentation algorithms by the research community. Through collaboration with leading teams, we combined top-performing algorithms into an ensemble model that overcomes the limitations of individual solutions. Our ensemble model achieved superior ischemic lesion detection and segmentation accuracy on our internal test set compared to individual algorithms. This accuracy generalized well across diverse image and disease variables. Furthermore, the model excelled in extracting clinical biomarkers. Notably, in a Turing-like test, neuroradiologists consistently preferred the algorithm's segmentations over manual expert efforts, highlighting increased comprehensiveness and precision. Validation using a real-world external dataset (N=1686) confirmed the model's generalizability. The algorithm's outputs also demonstrated strong correlations with clinical scores (admission NIHSS and 90-day mRS) on par with or exceeding expert-derived results, underlining its clinical relevance. This study offers two key findings. First, we present an ensemble algorithm (https://github.com/Tabrisrei/ISLES22_Ensemble) that detects and segments ischemic stroke lesions on DWI across diverse scenarios on par with expert (neuro)radiologists. Second, we show the potential for biomedical challenge outputs to extend beyond the challenge's initial objectives, demonstrating their real-world clinical applicability.

The widespread use of chest X-rays (CXRs), coupled with a shortage of radiologists, has driven growing interest in automated CXR analysis and AI-assisted reporting. While existing vision-language models (VLMs) show promise in specific tasks such as report generation or abnormality detection, they often lack support for interactive diagnostic capabilities. In this work we present RadVLM, a compact, multitask conversational foundation model designed for CXR interpretation. To this end, we curate a large-scale instruction dataset comprising over 1 million image-instruction pairs containing both single-turn tasks -- such as report generation, abnormality classification, and visual grounding -- and multi-turn, multi-task conversational interactions. After fine-tuning RadVLM on this instruction dataset, we evaluate it across different tasks along with re-implemented baseline VLMs. Our results show that RadVLM achieves state-of-the-art performance in conversational capabilities and visual grounding while remaining competitive in other radiology tasks. Ablation studies further highlight the benefit of joint training across multiple tasks, particularly for scenarios with limited annotated data. Together, these findings highlight the potential of RadVLM as a clinically relevant AI assistant, providing structured CXR interpretation and conversational capabilities to support more effective and accessible diagnostic workflows.

Automatic medical report generation (MRG), which possesses significant research value as it can aid radiologists in clinical diagnosis and report composition, has garnered increasing attention. Despite recent progress, generating accurate reports remains arduous due to the requirement for precise clinical comprehension and disease diagnosis inference. Furthermore, owing to the limited accessibility of medical data and the imbalanced distribution of diseases, the underrepresentation of rare diseases in training data makes large-scale medical visual language models (LVLMs) prone to hallucinations, such as omissions or fabrications, severely undermining diagnostic performance and further intensifying the challenges for MRG in practice. In this study, to effectively mitigate hallucinations in medical report generation, we propose a chain-of-medical-thought approach (CoMT), which intends to imitate the cognitive process of human doctors by decomposing diagnostic procedures. The radiological features with different importance are structured into fine-grained medical thought chains to enhance the inferential ability during diagnosis, thereby alleviating hallucination problems and enhancing the diagnostic accuracy of MRG. The code and dataset have been released at https://github.com/FRENKIE-CHIANG/CoMT.

Medical imaging plays a significant role in clinical practice of medical diagnosis, where the text reports of the images are essential in understanding them and facilitating later treatments. By generating the reports automatically, it is beneficial to help lighten the burden of radiologists and significantly promote clinical automation, which already attracts much attention in applying artificial intelligence to medical domain. Previous studies mainly follow the encoder-decoder paradigm and focus on the aspect of text generation, with few studies considering the importance of cross-modal mappings and explicitly exploit such mappings to facilitate radiology report generation. In this paper, we propose a cross-modal memory networks (CMN) to enhance the encoder-decoder framework for radiology report generation, where a shared memory is designed to record the alignment between images and texts so as to facilitate the interaction and generation across modalities. Experimental results illustrate the effectiveness of our proposed model, where state-of-the-art performance is achieved on two widely used benchmark datasets, i.e., IU X-Ray and MIMIC-CXR. Further analyses also prove that our model is able to better align information from radiology images and texts so as to help generating more accurate reports in terms of clinical indicators.

Developing an interpretable system for generating reports in chest X-ray (CXR) analysis is becoming increasingly crucial in Computer-aided Diagnosis (CAD) systems, enabling radiologists to comprehend the decisions made by these systems. Despite the growth of diverse datasets and methods focusing on report generation, there remains a notable gap in how closely these models' generated reports align with the interpretations of real radiologists. In this study, we tackle this challenge by initially introducing Fine-Grained CXR (FG-CXR) dataset, which provides fine-grained paired information between the captions generated by radiologists and the corresponding gaze attention heatmaps for each anatomy. Unlike existing datasets that include a raw sequence of gaze alongside a report, with significant misalignment between gaze location and report content, our FG-CXR dataset offers a more grained alignment between gaze attention and diagnosis transcript. Furthermore, our analysis reveals that simply applying black-box image captioning methods to generate reports cannot adequately explain which information in CXR is utilized and how long needs to attend to accurately generate reports. Consequently, we propose a novel explainable radiologist's attention generator network (Gen-XAI) that mimics the diagnosis process of radiologists, explicitly constraining its output to closely align with both radiologist's gaze attention and transcript. Finally, we perform extensive experiments to illustrate the effectiveness of our method. Our datasets and checkpoint is available at https://github.com/UARK-AICV/FG-CXR.

Automatic medical report generation supports clinical diagnosis, reduces the workload of radiologists, and holds the promise of improving diagnosis consistency. However, existing evaluation metrics primarily assess the accuracy of key medical information coverage in generated reports compared to human-written reports, while overlooking crucial details such as the location and certainty of reported abnormalities. These limitations hinder the comprehensive assessment of the reliability of generated reports and pose risks in their selection for clinical use. Therefore, we propose a Granular Explainable Multi-Agent Score (GEMA-Score) in this paper, which conducts both objective quantification and subjective evaluation through a large language model-based multi-agent workflow. Our GEMA-Score parses structured reports and employs NER-F1 calculations through interactive exchanges of information among agents to assess disease diagnosis, location, severity, and uncertainty. Additionally, an LLM-based scoring agent evaluates completeness, readability, and clinical terminology while providing explanatory feedback. Extensive experiments validate that GEMA-Score achieves the highest correlation with human expert evaluations on a public dataset, demonstrating its effectiveness in clinical scoring (Kendall coefficient = 0.70 for Rexval dataset and Kendall coefficient = 0.54 for RadEvalX dataset). The anonymous project demo is available at: https://github.com/Zhenxuan-Zhang/GEMA_score.

Hepatocellular carcinoma (HCC), ranking as the third leading cause of cancer-related mortality worldwide, demands urgent improvements in early detection to enhance patient survival. While ultrasound remains the preferred screening modality due to its cost-effectiveness and real-time capabilities, its sensitivity (59%-78%) heavily relies on radiologists' expertise, leading to inconsistent diagnostic outcomes and operational inefficiencies. Recent advancements in AI technology offer promising solutions to bridge this gap. This study introduces the Hierarchical Sparse Query Transformer (HSQformer), a novel hybrid architecture that synergizes CNNs' local feature extraction with Vision Transformers' global contextual awareness through latent space representation and sparse learning. By dynamically activating task-specific experts via a Mixture-of-Experts (MoE) framework, HSQformer achieves hierarchical feature integration without structural redundancy. Evaluated across three clinical scenarios: single-center, multi-center, and high-risk patient cohorts, HSQformer outperforms state-of-the-art models (e.g., 95.38% AUC in multi-center testing) and matches senior radiologists' diagnostic accuracy while significantly surpassing junior counterparts. These results highlight the potential of AI-assisted tools to standardize HCC screening, reduce dependency on human expertise, and improve early diagnosis rates. The full code is available at https://github.com/Asunatan/HSQformer.

Large, labeled datasets have driven deep learning methods to achieve expert-level performance on a variety of medical imaging tasks. We present CheXpert, a large dataset that contains 224,316 chest radiographs of 65,240 patients. We design a labeler to automatically detect the presence of 14 observations in radiology reports, capturing uncertainties inherent in radiograph interpretation. We investigate different approaches to using the uncertainty labels for training convolutional neural networks that output the probability of these observations given the available frontal and lateral radiographs. On a validation set of 200 chest radiographic studies which were manually annotated by 3 board-certified radiologists, we find that different uncertainty approaches are useful for different pathologies. We then evaluate our best model on a test set composed of 500 chest radiographic studies annotated by a consensus of 5 board-certified radiologists, and compare the performance of our model to that of 3 additional radiologists in the detection of 5 selected pathologies. On Cardiomegaly, Edema, and Pleural Effusion, the model ROC and PR curves lie above all 3 radiologist operating points. We release the dataset to the public as a standard benchmark to evaluate performance of chest radiograph interpretation models. The dataset is freely available at https://stanfordmlgroup.github.io/competitions/chexpert .

Hepatocellular carcinoma is the most spread primary liver cancer across the world (sim80\% of the liver tumors). The gold standard for HCC diagnosis is liver biopsy. However, in the clinical routine, expert radiologists provide a visual diagnosis by interpreting hepatic CT-scans according to a standardized protocol, the LI-RADS, which uses five radiological criteria with an associated decision tree. In this paper, we propose an automatic approach to predict histology-proven HCC from CT images in order to reduce radiologists' inter-variability. We first show that standard deep learning methods fail to accurately predict HCC from CT-scans on a challenging database, and propose a two-step approach inspired by the LI-RADS system to improve the performance. We achieve improvements from 6 to 18 points of AUC with respect to deep learning baselines trained with different architectures. We also provide clinical validation of our method, achieving results that outperform non-expert radiologists and are on par with expert ones.

Identifying cirrhosis is key to correctly assess the health of the liver. However, the gold standard diagnosis of the cirrhosis needs a medical intervention to obtain the histological confirmation, e.g. the METAVIR score, as the radiological presentation can be equivocal. In this work, we propose to leverage transfer learning from large datasets annotated by radiologists, which we consider as a weak annotation, to predict the histological score available on a small annex dataset. To this end, we propose to compare different pretraining methods, namely weakly-supervised and self-supervised ones, to improve the prediction of the cirrhosis. Finally, we introduce a loss function combining both supervised and self-supervised frameworks for pretraining. This method outperforms the baseline classification of the METAVIR score, reaching an AUC of 0.84 and a balanced accuracy of 0.75, compared to 0.77 and 0.72 for a baseline classifier.