Beyond Accuracy: Quantifying Pulmonary Attribution in Anatomy-Guided Chest X-Ray Classification Under Domain Shift

Deep-learning models can achieve strong chest X-ray (CXR) classification performance without establishing whether their predictions predominantly rely on pulmonary image content. This study evaluates pulmonary attribution containment as an anatomy-related reliability property distinct from diagnostic performance. We propose DBCA-SegNet-MGAP, a multi-task anatomy-guided CNN-Transformer framework that combines complementary feature representations through bidirectional cross-backbone attention, predicts a soft lung mask, and incorporates this anatomical prior directly into classification through Mask-Guided Adaptive Global Average Pooling (MGAP). Pulmonary attribution containment is quantified using the Anatomical Local Energy Ratio (ALR) and high-intensity cumulative ALR (cALR@0.9). Experiments were repeated across three training seeds using the COVID-19 Radiography Database for four-class internal testing and a locked Shenzhen-to-Montgomery protocol for zero-shot external tuberculosis testing. On COVID-19, the proposed model achieved a weighted F1 of $0.9615 \pm 0.0015$ and macro ROC-AUC of $0.9906 \pm 0.0007$. In an architecture-matched dual-bridge comparison, replacing conventional GAP with MGAP increased ALR from $0.3878 \pm 0.0098$ to $0.7086 \pm 0.0104$ and cALR@0.9 from $0.5265 \pm 0.0101$ to $0.9905 \pm 0.0018$, while weighted F1 remained essentially unchanged ($0.9618 \pm 0.0015$ vs. $0.9615 \pm 0.0015$). Under locked external transfer to Montgomery, ROC-AUC remained $0.9080 \pm 0.0043$ and pulmonary ALR remained $0.6466 \pm 0.0081$, whereas weighted F1 decreased to $0.7528 \pm 0.0080$ and ECE increased to $0.1683 \pm 0.0055$. These findings show that diagnostic discrimination, calibration, and pulmonary attribution containment are distinct model properties and support their joint evaluation under internal testing and external domain shift.

Subtraction-Based Tumor Segmentation and Lesion-Centered pCR Prediction for the MAMA-MIA Challenge

We describe the submission of team FME to the MAMA-MIA Challenge, which evaluated primary tumor segmentation and prediction of pathological complete response (pCR) from pretreatment dynamic contrast-enhanced breast MRI on an external multi-country cohort. For segmentation, we trained a five-fold residual-encoder nnU-Net ensemble using only the first post-contrast minus pre-contrast image, combined with mirroring test-time augmentation and largest-connected-component filtering. For pCR prediction, we ensembled 25 pretrained 3D video classifiers trained on lesion-centred crops from the pre-contrast and first two post-contrast volumes. FME ranked second in both tasks. The segmentation method achieved a combined performance-fairness score of 0.882, with Dice 0.713 and normalized Hausdorff distance 0.099. The pCR method achieved a combined score of 0.664, balanced accuracy of 0.541, and equalized-odds disparity of 0.212. The results indicate that subtraction-based input and ensembling support robust tumor segmentation under cross-site domain shift, whereas pCR prediction from baseline DCE-MRI alone remains limited. For the submission repository, see https://github.com/FraunhoferMEVIS/MAMA-MIA-Challenge-FME

CARD: Calibration via Agreement in Reverse Diffusion for Out-of-Domain MRI Segmentation

Probability calibration aligns model confidence with predictive accuracy, enabling clinicians to identify unreliable segmentation regions. This alignment breaks down under domain shift, where artifacts and unseen protocols produce confident errors. Existing post-hoc methods adapt the correction at test time, conditioning on predictive entropy, the logit pattern, or augmentation response, but each proxy is read from the terminal prediction, the very quantity that shift corrupts. This motivates reliability evidence beyond the terminal prediction, which categorical diffusion provides in two ways. First, a generative shape prior keeps a capacity-limited reference intact when appearance is corrupted, so its disagreement with the primary segmentor highlights primary-model errors. Second, every reverse step yields a class distribution, separating persistent disagreement from transient discrepancy. Aggregated over the trajectory, this disagreement correlates with Dice at 0.788, against 0.521 for a matched discriminative control. We therefore propose CARD (Calibration via Agreement in Reverse Diffusion), which maps the temporal aggregate of this disagreement to a temperature field applied per pixel across all classes, so that confidence changes while the segmentation does not. Across cardiac, prostate and brain MRI shifts, CARD lowers calibration error in 45 of 49 comparisons against the strongest baseline in each setting.

Can You Trust Frozen Hematology Foundation Models under Acquisition Shift?

Frozen hematology foundation-model (FM) embeddings reach near-saturated in-domain white-blood-cell (WBC) accuracy, but clinical deployment demands reliability across scanners, sites, stains and preparation pipelines. We audit 15 frozen encoders (hematology, pathology, and general vision) across four public single-cell acquisition domains along two axes: accuracy robustness and calibration. In-domain linear-probe macro-F1 is saturated (0.98-0.997), yet cross-dataset macro-F1 drops 34-72% and rankings re-order: DinoBloom-L, the in-domain best, falls to 10th of 15 on the most-shifted target (MLL23) at the benchmark's shared 224-px input, behind RedDino and several general and pathology encoders. Rank transfer is probe-dependent: 1-NN retrieval is more stable on average than a source-fitted linear head (median $ρ$ 0.65 vs 0.45), but neither probe universally predicts target robustness. Calibration also collapses: source-trained probes are nearly calibrated in-domain (expected calibration error, ECE, 0.004) but confidently wrong off-domain (ECE 0.35), and source-fitted temperature scaling transfers poorly. We further audit pretraining exposure and identify MLL23 as DinoBloom's internal cohort; because DinoBloom's only held-out dataset is also our source domain, this benchmark cannot isolate exposure from scanner-associated shift. Label-free adaptation and marginal-entropy-based model selection appear safe under balanced evaluation but fail under realistic WBC class-prior shift. Class-Balanced Re-standardization (CBR), a training-free pseudo-label-balanced feature normalization, improves all evaluated target-prior scenario means and partially improves calibration, although encoder-level exceptions and residual miscalibration remain. Hematology FM benchmarks must therefore jointly audit accuracy, calibration, exposure, and class-prior robustness.

Test-Time Adaptation for ECG Classification via SQI-Gated Self-Training and Beat-Rhythm Consistency

Deep learning models for electrocardiogram (ECG) classification often suffer from significant performance degradation when deployed in unseen domains due to shifts in acquisition devices and patient populations. Test-time adaptation (TTA) offers a practical solution by adapting models using only unlabeled data at inference time. However, existing TTA methods often underperform on ECG tasks, since naive online updates ignore the hierarchical beat-rhythm structure of cardiac cycles and are vulnerable to signal artifacts, which leads to unstable adaptation and model drift. We propose BeatRhythm-TTA, an ECG-tailored TTA framework that explicitly accounts for ECG's noisy observations and structured beat-rhythm semantics under domain shift. First, to handle pervasive ECG artifacts, we introduce a Signal Quality Index (SQI)-gated adaptation scheme that selectively filters out low-quality signals to prevent harmful updates. Second, to leverage ECG's beat-rhythm semantics, we enforce dual-level consistency so the model preserves beat morphology and rhythm dynamics while adapting to shifted acquisition conditions. Extensive experiments on multi-label ECG diagnosis across three adaptation protocols, using PTB-XL as the source domain and CPSC2018/Georgia as two target domains, demonstrate the effectiveness of our method, yielding an average +2.70% relative improvement in Macro-F1 over the best competing method.

GET: Generative Embedding Translation for Medical Image Segmentation

Generative segmentation provides an alternative to direct pixel-wise prediction by operating on learned latent representations, but effective image-to-mask translation must preserve target structure while remaining computationally efficient. We propose Generative Embedding Translation (GET), a structured embedding-translation framework that progressively transforms image embeddings into mask embeddings within the frozen latent space of a Stable Diffusion VAE. GET uses a U-Net-style Embedding Translation Network with 1.07M trainable parameters, combining Mobile Bottleneck Convolutions, Subsampled Self-Attention, and Multi-scale Feature Enrichment for local modeling, global context, and multi-scale refinement. Across five medical segmentation datasets, GET outperforms generative, CNN, and Transformer baselines. Compared with the strongest generative baseline, GMS, GET improves average Dice and IoU by 0.93% and 1.26%, reduces HD95 by 0.81 pixels, and uses 31.41% fewer trainable parameters. Under bidirectional BUS-BUSI domain shift, GET further improves Dice and IoU by 3.51% and 3.39%, while reducing HD95 by 27.37 pixels. Our code is available at: https://github.com/maklachur/GET.

Learning Prostate Anatomy at Test Time for Cancer Detection in Micro-Ultrasound

Domain shift across clinical centers using different imaging hardware or acquisition protocols remains a fundamental barrier to deploying deep learning models for prostate cancer (PCa) detection. Existing test-time adaptation (TTA) methods address distribution shift through entropy minimization or augmentation-based self-supervision, correcting for statistical differences in image appearance but ignoring the anatomical structure of the target domain. We propose ANT, a segmentation-guided TTA framework that adapts a pretrained cancer detection encoder to the target domain by solving an auxiliary prostate segmentation task at test time, supervised by pseudo-masks from a frozen pretrained segmentation network. By aligning encoder representations to prostate anatomy in the target domain, ANT corrects domain-specific feature drift while preserving cancer-discriminative structure. The model was trained on 693 patients imaged with an earlier-generation micro-ultrasound scanner in a multi-center clinical trial, and evaluated on 118 patients acquired with a newer-generation system across two centers in another clinical trial. Under a leave-one-center-out protocol with identical evaluation conditions across all methods, ANT improves mean AUC by 2.9% and 3.6% at the biopsy-core and patient levels, respectively, over no adaptation, outperforming TTA baselines. Code is available at: https://github.com/ObedDzik/ant.git.

Bound-Aware Per-Organ Recall Risk Control for Multi-Organ CT Segmentation under Clinical Domain Shift

Distribution-free risk control adds organ-specific recall guarantees to frozen segmentation. We calibrate per-organ thresholds for an AMOS-trained nnU-Net, audit transfer to RAOS, and estimate local re-certification cost using case-level voxel false-negative rate (FNR). The AMOS control passes, but $7/12$ organs exceed $α{=}0.10$ after transfer; smaller calibration sets can mask exceedances with conservative or vacuous thresholds. Risk-Controlling Prediction Sets (RCPS) give high-probability control of population-mean risk, whereas Conformal Risk Control (CRC) gives weaker expectation control. Both require exchangeability; fixed and global thresholds give no per-organ guarantee. The Waudby--Smith--Ramdas (WSR) betting bound re-certifies six Tier-1 organs with 25 local cases, versus 30--40 for Hoeffding--Bentkus (HB). CRC needs 10--15 but has a heavier individual-case tail. No Tier-2 organ meets our illustrative precision criterion with 25 cases.

Beyond Simulated Benchmarks: Evaluating Motion Representations for Fall Detection Under Real-World Data Scarcity

Falls are a major health concern for older adults, and wearable sensors have been widely explored for detecting falls and enabling timely intervention. However, real-world falls are extremely rare: collecting 100 of them requires an estimated 100,000 days of monitoring, resulting in severely limited labelled data for training machine learning models. Consequently, many approaches rely on simulated datasets, often reporting high laboratory performance but limited real-world generalisation. We present a systematic evaluation of motion representations for wearable fall detection under real-world data scarcity. Using accelerometer signals, we compare interval-based, kernel-based, symbolic, and foundation model representations. As an interpretable baseline, we additionally investigate a lightweight symbolic representation that converts short motion segments into symbolic sentences augmented with physically-grounded impact descriptors. Experiments use FallAllD, a simulated falls dataset, and FARSEEING, a clinically verified real-world falls dataset. Through cross-validation, controlled data scarcity, and cross-dataset transfer, we examine how representation choices affect robustness under realistic deployment. Our results reveal that highly parameterised kernel and foundation models excel on simulated data but degrade severely under both data scarcity and domain shift. Although the interval-based representation achieves the strongest absolute real-world performance, augmenting a symbolic representation with physically-grounded impact descriptors yields the smallest degradation under domain shift and retains detection sensitivity under extreme scarcity, albeit at lower precision. These findings highlight the importance of evaluating beyond simulated benchmarks and show that representation choice is critical for deployable fall detection given the scarcity of real-world data.

Retrieval-Augmented Vision Foundation Models for Robust Leukemia Cell Classification across Multiple Microscopy Datasets

Leukemia cell image classification is challenged by real-world domain shifts from acquisition, staining, illumination, and site protocols, causing single-dataset models to generalize poorly in real clinical scenarios. This work presents a robust framework for leukemia classification across multiple heterogeneous datasets using a two-stage pipeline with a pretrained vision foundation model. Stage 1 performs binary classification (leukemia vs. non-leukemia) and is trained using 122,167 single-cell images. Stage 2 is conditionally applied to Stage 1 positives to perform subtype classification into Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML), trained using 69,400 single-cell images. Labels are harmonized across five heterogeneous datasets to enable cross-dataset training, and performance is evaluated on a held-out dataset protocol to assess domain-shift generalization. Within this pipeline, three encoders are benchmarked (DinoBloom, pretrained on single-cell images; BiomedCLIP, pretrained on biomedical data; and CLIP as a general-purpose model) under linear probing, Low-Rank Adaptation (LoRA), and a Retrieval-Augmented Classification (RAC) module that retrieves the top-k most similar cell images to provide cytomorphological grounding. The objective is to quantify how much domain-specific pretraining contributes to performance under domain shift, and whether cost-effective adaptation and retrieval can be a viable alternative to expensive domain-specialized pretraining. The held-out protocol additionally serves as a diagnostic tool, revealing when classification performance is attributable to dataset-specific artifacts rather than to cytomorphological features.

Biologically Informed Representation Learning for Robust Cross-Center Generalization of MALDI-TOF Mass Spectrometry

Machine learning models for MALDI-TOF mass spectrometry have shown considerable promise for clinical microbiology tasks such as microbial identification and antimicrobial resistance prediction. However, their deployment across institutions remains limited by domain shift, as acquisition-specific variability often leads models to capture technical artifacts rather than transferable biological information. Existing representation learning approaches primarily address this problem through statistical domain alignment while largely overlooking the biological supervision naturally available in microbiology datasets. We introduce DALMA, a probabilistic representation learning framework that jointly models acquisition-specific variability and biological supervision to learn biologically structured latent representations. By combining domain-specific reconstruction with biologically guided representation learning, DALMA learns transferable representations that generalize across heterogeneous clinical centers without requiring institution-specific components at inference, enabling zero-shot deployment on previously unseen sites. We evaluate DALMA on a multi-center benchmark comprising seven datasets from three countries. DALMA consistently achieves state-of-the-art zero-shot microbial identification across two held-out clinical centers, while the learned representations also transfer effectively to antimicrobial resistance prediction. Furthermore, latent-space novelty estimation enables reliable selective prediction under previously unseen domain shifts. These results demonstrate that biologically informed representation learning provides an effective strategy for robust and transferable ML in clinical microbiology.

Bayesian adaptively-weighted ensembles for few-shot abdominal segmentation

Few-shot learning has emerged as a promising approach for anatomical segmentation when labelled data are scarce. However, different few-shot learning algorithms exhibit complementary strengths and weaknesses, with performance varying across anatomical targets and institutions. Existing few-shot segmentation ensembles, that combine predictions from multiple algorithms, typically employ fixed weighting schemes and therefore cannot adjust model contributions according to the target domain. In this work, we propose a Bayesian adaptively-weighted ensemble framework for segmentation under label scarcity and domain shift. Multiple few-shot segmentation algorithms are first adapted using a small labelled support set. Bayesian optimisation is then used to automatically identify ensemble weights that maximise segmentation performance on a target-domain validation set. The learned weights are subsequently fixed and applied to combine predictions on previously unseen query images from the target domain. The proposed framework is evaluated on the Cross-institution Male Pelvic Structures dataset using held-out anatomical structures and institutions to simulate simultaneous label scarcity and institutional domain shift. Results demonstrate statistically significant improvements over individual few-shot learners, fixed-weight ensembles, training-from-scratch baselines and recent state-of-the-art ensembling approaches. By adapting model contributions to the target anatomy and institutional domain, the proposed framework provides a practical mechanism for deploying segmentation systems to new clinical sites under severe annotation constraints.

DistMedVL: Distributional Vision-Language Alignment for Uncertainty-Aware Medical Image Segmentation

Cross-modal alignment of visual and textual representations is fundamental to multimodal medical image understanding, yet remains hindered by uncertainty in both modalities under real-world clinical conditions. Existing vision-language segmentation methods rely on deterministic cross-modal matching, which overlooks aleatoric uncertainty from ambiguous boundaries and epistemic uncertainty from limited training data, leading to fragile performance under domain shift. To address this issue, we propose DistMedVL, a probabilistic vision-language framework that introduces a lightweight Probabilistic Cross-Modal Adapter (PCM-Adapter) upon frozen encoders to explicitly model representational uncertainty. Specifically, the PCM-Adapter comprises two sequential modules for progressive probabilistic alignment. We first devise a Mahalanobis Alignment Module (MAM) that models textual tokens as Gaussian distributions and computes patch-text compatibility via Mahalanobis distance, yielding variance-conditioned matching that downweights unreliable feature dimensions. Moreover, we devise a Distribution Flow Module (DFM) that estimates modality-wise confidence parameters and performs vision-guided refinement of textual distributions, accommodating distributional variation across imaging modalities. Extensive experiments across eight medical segmentation benchmarks demonstrate that DistMedVL outperforms state-of-the-art methods with only 6.3M trainable parameters, exhibiting superior data efficiency, perturbation robustness and cross-dataset generalization.

When Oracle Conditioning Misleads Deployment: Conditioning-Availability Bias in Echocardiographic Segmentation

Conditional segmentation models may be trained and evaluated with auxiliary signals cleaner than those available at deployment. We study this protocol-level manifestation of shortcut learning and auxiliary-variable shift in phase-conditioned echocardiographic segmentation. The complementary gap pair measures loss on the deployable oracle-estimated pathway and probes sensitivity on the oracle-random pathway. On held-out CAMUS data, one strong-cyclic, oracle-selected run fails severely with estimated phase, while sensitivity to incorrect phase persists across three runs. On EchoNet-Dynamic, the current estimator remains usable, but random-phase testing reveals strong latent sensitivity. Deployment-aware checkpoint selection and phase perturbation reduce both gaps with little change in mean Dice. Exploratory subgroup analyses quantify variation across measured strata, and a downstream ejection fraction (EF) audit shows that recovering segmentation does not necessarily recover EF error or signed bias. Together, the gaps test whether oracle-conditioned performance survives the inference pathway actually available at deployment.

Test-time Adaptation of Pelvic Bone Segmentation Models via Dynamic Reliability-Guided

Reliable pelvic bone segmentation (PBS) from CT is essential for robot-assisted pelvic trauma surgery, yet deploying a source-trained model to a new hospital suffers from severe performance degradation due to cross-center domain shifts. While test-time adaptation (TTA) enables online model adaptation without accessing source data, existing methods show limited effectiveness for PBS, facing challenges including boundary degradation, anatomical inconsistency under domain shifts, and voxel-level class imbalance. To address these challenges, we propose a novel closed-loop dynamic Reliability-Guided TTA framework (ReGA) for PBS. Specifically, we introduce a pseudo-label reliability criterion termed Segmentation Inference Consistency Evaluation (SICE), which jointly measures region overlap and boundary deviation via dropout-based ensemble predictions. Based on SICE, a trust-weighted refinement module adaptively updates features to mitigate boundary errors in pseudo-labels. Furthermore, a confidence-weighted region-level contrastive learning strategy is proposed to enforce anatomical consistency. Finally, ReGA follows the teacher-student (TS) scheme to alleviate voxel-level class imbalance. Experiments on three heterogeneous 3D pelvic CT datasets demonstrate that ReGA consistently outperforms state-of-the-art TTA methods, enabling effective adaptation of the source-trained PBS model to unseen clinical domains. The code is available at https://github.com/Ren-ling/ReGA.

MedSAM2-Anatomy: Training-Free Inference-Time Optimization for Musculoskeletal Segmentation

High-resolution 3D segmentation of hip and shoulder anatomy from CT and MRI is essential for surgical planning, yet frozen segmentation models often fail under domain shift. CNN-based expert models are fully automatic but lack adaptability, whereas promptable foundation models generalize better but require manual prompting. We present MedSAM2-Anatomy, a training-free inference-time optimization framework that improves frozen segmentation models without retraining or human interaction. A frozen expert model generates anatomical priors that are automatically converted into multiple prompt hypotheses for a frozen 3D foundation model. Candidate masks are fused while anatomically implausible priors are rejected. No model weights are updated and no manual prompts are required. TotalSegmentator and MedSAM2 are used as representative expert and foundation models, allowing the contribution of the inference policy to be isolated. Evaluation on the independent Balgrist-V0 CT and MRI cohorts shows that inference-time optimization increases median Dice from 0.71 to 0.92 on hip MRI and from 0.89 to 0.92 on shoulder CT, while reducing median HD95 on hip MRI from 22.0 mm to 5.0 mm. On public TotalSegmentator benchmarks, the expert model remains strongest, indicating that the optimal fusion strategy depends on the reliability of the expert prior. These results demonstrate that training-free inference-time optimization provides a practical strategy for improving frozen segmentation models without manual prompting.

Step-Attention Refinement of DINOv3 Features for Efficient Anterior Eye Segmentation

Anterior eye segment (AES) segmentation is a key component of both ocular biometrics and emerging clinical image analysis applications. However, heterogeneous acquisition conditions and limited annotations in medical settings hinder the robustness and generalization of existing methods. Foundation models (FMs) such as DINOv3 offer strong transfer capabilities, but efficiently adapting their representations to dense prediction tasks remains challenging. In this study, we investigate robust AES segmentation in clinical settings, and propose a lightweight architecture built upon a distilled DINOv3 ViT-Small backbone. We introduce a step-attention feature refinement module that progressively adapts multi-level transformer representations before convolutional decoding, enabling efficient exploitation of pretrained features with few parameters. We evaluate the proposed approach on a private dataset of 333 clinically acquired AES images spanning eight ophthalmic acquisition protocols and annotated for seven anatomical classes. Compared with convolutional and transformer-based baselines, including DINOv3-based methods, our approach achieves the best overall performance, reaching 85.55\% mIoU when fully fine-tuned. It also demonstrates the strongest robustness to domain shift across four unseen public AES segmentation datasets. These results establish a strong baseline for robust AES segmentation in clinical settings and highlight the importance of decoder design for effectively adapting FMs representations to medical segmentation tasks.

OrthKD: Extracting Generalized Clinical Knowledge from Heterogeneous Teachers for Lightweight Deployment

Deploying diabetic retinopathy (DR) screening models in primary care requires edge-efficient systems that remain accurate, safe, and reliable under domain shift. Multi-teacher knowledge distillation (KD) is a natural compression strategy, but existing approaches largely assume that all teachers provide equally trustworthy supervision. In our setting, this assumption fails: a strong CNN teacher (EfficientNet-B3, 0.876 QWK) and a weaker Transformer teacher (Swin-Base, 0.830 QWK) are complementary, yet the Transformer's logits can still mislead the student. We therefore propose OrthKD, a selective-trust distillation framework that transfers full supervision from the strong CNN, uses feature-only distillation from the weak ViT, and enforces orthogonality between teacher-specific student projections to encourage complementary rather than redundant evidence. This design preserves local lesion precision, injects global structural context, and improves robustness to distribution shift. On 132,049 retinal images, a 5.4M-parameter MobileNetV3 student reaches 0.885 QWK on EyePACS and improves zero-shot Messidor-2 performance from 0.507 to 0.728 QWK, while also achieving strong referral AUC and calibration. These results show that selectively distilling heterogeneous teachers can enable practical DR screening on resource-constrained devices.

Robustifying pathology foundation models via fine-tuning

Pathology foundation models (FMs) produce powerful tile-level representations which remain sensitive to scanner and staining variability, undermining deployment across laboratories. We develop a novel fine-tuning recipe that improves the robustness of pathology FMs to acquisition factors. Applied to ten different FMs, our fine-tuning strategy consistently improves robustness for every model as well as downstream performance, with no observed trade-off. On average, it raises the PathoROB robustness index by 23% (from 0.72 to 0.87) and increases the overall cross-benchmark performance by 43% on Patho-Bench, HEST and THUNDER combined, with individual gains reaching up to 72% in robustness (Phikon-v2) and 76% in performance (Midnight-12k). We publicly release the fine-tuned versions of Phikon-v2 (Phaet) and Midnight-12k (Mascaret) at https://huggingface.co/wearewaiv/models.

Post-Operative Glioma Segmentation via Loss Stabilization, Normalization and Subspace Attention

Tracking residual tumor after surgery is essential for catching recurrence early, but automating post-operative glioma segmentation remains a difficult task. Although transformer-based architectures, such as SwinUNETR, achieved impressive results, few studies test how well they generalize across clinical protocols. In this paper, we conduct an ablation study on the MU-GLIOMA-POST and UCSF-ALPTDG datasets and show that the standard Generalized Dice Loss (GDL) is unstable under domain shift: the Whole Lesion (WL) Dice drops from 0.88 on the internal validation set to 0.73 on the external UCSF test set. To address this, we pair brain-masked percentile normalization with voxel-level contrastive learning. We also propose a Subspace-Aware Class Attention (SACA) module that re-calibrates the bottleneck features and raises Enhancing Tumor (ET) sensitivity by 8% (9.1% relative improvement) on internal validation. Ensembling these refinements with nnU-Net brings every stable configuration to a WL Dice of 0.94, and the SACA variant ensemble achieves the best boundary error (HD95) of 2.92 mm on MU-GLIOMA-POST.

Benchmarking the Domain Gap: Model Selection Instability Under Domain Shift in Video Capsule Endoscopy

Video capsule endoscopy (VCE) classification is typically evaluated within a single dataset, yet clinical deployment demands robustness across acquisition sources, labeling policies, and patient populations. We examine this gap using Kvasir-Capsule, Capsule Vision 2024 (CV2024), and a shared-label subset of Galar. We fine-tune a suite of general-domain pretrained backbones on the official Kvasir-Capsule folds under a standardized protocol and evaluate the same checkpoints on two non-source targets within a documented shared-label decision space. We find that the predictive value of in-domain ranking is target-dependent: Kvasir-Capsule ranking aligns more closely with Galar than with CV2024, while the two non-source targets agree only weakly. Consequently, the strongest in-domain backbone leads on one target yet falls to mid-pack on the other, and no single evaluation target reliably predicts the others. A second CV2024-trained configuration set reproduces this target-dependent instability. We conclude that capsule endoscopy model selection should report cross-target ranking stability rather than peak single-dataset performance.

A Systematic Benchmark of Intensity Normalisation Methods for 3D Knee MRI Segmentation and Cross-Domain Generalisability

Robust out-of-the-box performance is essential for the clinical deployment of deep learning models in medical imaging. An important but underexplored factor affecting model generalisability is intensity normalisation, particularly for magnetic resonance imaging (MRI), where image intensities vary across scanners and protocols. In this study, we systematically compared seven normalisation methods and their impact on the performance of a 3D U-Net model for meniscus segmentation from knee MRI. The methods included standard scaling approaches, histogram-based techniques, and a Gaussian Mixture Model (GMM)-based method. Models were trained on the IWOAI 2019 dataset and evaluated on both internal and external test sets (SKM-TEA) to assess generalisability. Performance was similar internally but differences were significant on external data, with Z-score, Nyúl histogram matching, and CLAHE showing greater robustness than other methods. However, these differences were small compared to the significant performance drop observed between datasets. Overall, while intensity normalisation had a measurable effect on model generalisability, its impact was limited relative to the effects of domain shift, highlighting the need for complementary strategies for robust deployment.

Domain Shift in Echocardiography: Interpretable Quantification and Prediction of Cross-Dataset Left Ventricular Segmentation

Cross-dataset generalisation remains a major barrier to clinical deployment of echocardiographic left ventricular segmentation, yet the sources of this shift are rarely disentangled. We examined whether transfer degradation could be estimated before deployment using handcrafted ultrasound descriptors, VAE latent features, and segmentation-derived latent features across six echocardiographic datasets. Geometry-aware preprocessing substantially improved several poor transfer cases, suggesting that much of the apparent domain shift reflects field-of-view and framing inconsistencies rather than intrinsic acoustic differences alone. Intensity z-normalisation changed dataset separability by less than 0.005, indicating that brightness and contrast are not the dominant shift axis. Absolute Dice drop on held-out source-target pairs was predicted with an R-squared value of 0.612, an MAE of 0.082, and a Spearman rho of 0.681. The variant without LV and fan-shaped features retained approximately 70% of this explanatory power, supporting mask-free transfer-risk monitoring. The most informative discrepancy measure depended on the representation, with CMD strongest in z-normalised handcrafted features, with an absolute r of approximately 0.86 and an R-squared value of approximately 0.70; log-Wasserstein strongest in VAE space, with an r of approximately -0.90 and an R-squared value of approximately 0.81; and log-MMD strongest in LV-segmentation latent features, with an r of approximately -0.92 and an R-squared value of approximately 0.84. Apparent vendor effects were largely dataset-confounded. Echocardiographic domain shift is therefore structured and measurable, and its impact on segmentation can be partly reduced through geometry-aware preprocessing and anticipated using representation-specific transfer-risk estimation.

Cross-Dataset Generalization in Breast MRI Tumor Classification via Class-Wise Dataset Mixing

Breast MRI is highly sensitive for detecting breast tumors, but exams contain many slices and require substantial reading time. Deep learning models often perform well on internal splits but can fail across institutions because of domain shift and dataset-origin bias. We study this failure mode for binary breast MRI tumor classification. EfficientNet-B3 and WaveViT-Small are trained using Duke Breast Cancer MRI and fastMRI, and evaluated only on the independent multi-center MAMA-MIA cohort. In a deliberately confounded setup, where label is perfectly correlated with dataset origin, external accuracy is near chance (0.5048--0.5265), despite very high recall. We then construct a mixed training set in which each class contains samples from both Duke and fastMRI, while preserving patient-level splitting, augmentation, and leakage controls. On MAMA-MIA, dataset mixing improves accuracy/F1 to 0.8463/0.8625 for WaveViT-Small and 0.8884/0.8994 for EfficientNet-B3. These results show that controlling dataset-origin bias is important for reliable breast MRI classification.

Spatial Normalization for Cross-Domain Retinal Layer Segmentation in Optical Coherence Tomography

Retinal layer segmentation in Optical Coherence Tomography (OCT) is a fundamental step for extracting quantitative biomarkers of retinal structure. Indeed, there is a growing interest in the analysis of OCTs in the context of neurodegenerative diseases. However, segmentation remains challenging due to speckle noise, shadowing artifacts, low contrast between adjacent layers, anatomical variability across subjects, and domain shifts arising from different acquisition protocols and clinical populations. While deep learning methods have achieved remarkable performance, their robustness and generalization across heterogeneous datasets remain limited. In this work, we investigate the role of spatial normalization as a preprocessing strategy to mitigate geometric domain shifts and improve the consistency of retinal layer segmentation. Inspired by standard practices in neuroimaging, we introduce a fovea-centered normalization framework that aligns OCT volumes into a common anatomical reference. We perform a comprehensive evaluation of state-of-the-art deep learning architectures. To provide a comprehensive assessment of segmentation quality, we combine conventional overlap-based metrics at B-scan level with topology-aware metrics at A-scan level and thickness-based measures at the en-face level. In cases where a ground truth is not available, we propose topology violation quantitative metrics that do not require ground truth annotations and a thickness-based qualitative assessment that captures structural consistency and clinically relevant patterns at the en-face level. The results demonstrate the importance of spatial normalization in OCT segmentation pipelines toward the development of robust and clinically meaningful retinal analysis tools, enabling reliable biomarker extraction and downstream computational analysis in neurodegenerative research.

Dataset-Origin Signatures and Shortcut Learning in Screening Mammography AI: A Cross-Dataset Case Study

Reliable AI for screening mammography requires training data representative of the low cancer prevalence and subtle abnormalities found in screening populations. We examined whether supplementing such data with biopsy-confirmed cases from abnormal-enriched external datasets improves performance. Using the Newfoundland and Labrador Breast Screening Dataset (NLBSD) alongside CBIS-DDSM and CMMD, we evaluated an EfficientNet-B5 encoder initialized with Mammo-CLIP weights as a frozen linear probe under consistent preprocessing and patient-level splits. The NLBSD-only model achieved an AUC-ROC of 0.737 (95% CI [0.686, 0.785]). Adding external positive cases reduced performance in every configuration (AUC-ROC = 0.620--0.644; DeLong test, Holm-corrected $p < 0.05$), with degradation increasing as additional sources were introduced. Domain-matched evaluation produced modest gains only when the training and test domains coincided, and no configuration surpassed the NLBSD-only model. As a diagnostic, we reframed the task as predicting each examination's dataset of origin. The datasets were separated almost perfectly despite identical preprocessing, indicating that dataset-specific characteristics strongly influence the learned representation. These findings show that naïvely pooling abnormal-enriched mammography datasets can introduce domain shift that outweighs the benefit of additional positive cases. Differences in acquisition, intensity mapping, and dataset construction persist after normalization, motivating domain-aware strategies for combining heterogeneous mammography datasets.

CRISP: Constrained Refinement via Iterative Squeezing Process for Robust Medical Image Segmentation under Domain Shift

Distribution shift in medical imaging remains a central bottleneck for the clinical translation of medical AI. Failure to address it can lead to severe performance degradation in unseen environments and exacerbate health inequities. Existing methods for domain adaptation are inherently limited by exhausting predefined possibilities through simulated shifts or pseudo-supervision. Such strategies struggle in the open-ended and unpredictable real world, where distribution shifts are effectively infinite. To address this challenge, we adopt the "Rank Stability of Positive Regions" as a working assumption under distribution shift, and use it to derive robust spatial hints for source-only segmentation. Guided by this assumption, we propose CRISP, a model-agnostic framework that, unlike deployment-time adaptation, requires no test-time parameter updates and no target-domain data--a target-free, plug-in refinement framework that segments with frozen weights. Rather than using ranking to directly output masks, CRISP exploits the stability of probability rankings under distribution shift to derive robust spatial priors. Via latent feature perturbation, perturbation-invariant high-grade regions define a high-precision (HP) core, while voxels that remain potentially foreground under at least one perturbation define a high-recall (HR) support; these dual priors are then recursively refined under perturbation. We then design an iterative training framework that progressively squeezes HP and HR toward the final segmentation. Extensive evaluations on multi-center cardiac MRI and CT-based lung vessel segmentation demonstrate CRISP's superior robustness, significantly outperforming state-of-the-art methods with striking HD95 reductions of up to 0.14 (7.0% improvement), 1.90 (13.1% improvement), and 8.39 (38.9% improvement) pixels across multi-center, demographic, and modality shifts, respectively.

The 2nd International StepUP Competition for Biometric Footstep Recognition: From Steps to Strides

The International StepUP Competition Series was launched to advance research in pressure-based footstep biometrics through a standardized and challenging evaluation framework. Using the large-scale StepUP-P150 dataset (with more than 200,000 high-resolution dynamic footsteps from 150 individuals) and a previously unreleased test set, the 2nd edition of the competition addressed three key challenges: (1) generalization to unseen users with limited enrollment data, (2) robustness to domain shift caused by variations in footwear and walking speed and (3) effective fusion of paired left-right footsteps. While the first two challenges built on the inaugural competition, this edition introduced more extreme cross-domain conditions and moved beyond isolated footsteps to stride-level verification, enabling new opportunities for representation learning and inter-step information fusion. The competition attracted 26 registrants from academia and industry, with a best equal error rate of 8.00% achieved by the ArogyaPandit Research Team using a spatiotemporal CNN combined with an ensemble-based scoring strategy. The top solutions showcase the value of harnessing temporal patterns and of incorporating inference-time normalization and calibration strategies to improve scoring. However, the results also reveal that recognizing users in unseen personal footwear remains a challenge, especially in the presence of distractors with similar characteristics.

Benchmarking the Robustness of Foundation Models for Mammography under Domain Shift

Foundation models are increasingly used as image feature extractors for mammography, but their robustness under external domain shift remains unclear. We benchmark 15 foundation-model backbones across breast density, BI-RADS severity, and cancer status using a unified frozen-backbone linear-probe protocol, training on 3 source datasets and evaluating on 12 task-compatible out-of-distribution (OOD) datasets after label harmonization. Mammography-specific vision-language models (Mammo-FM and MaMA) provide the strongest mean OOD performance, but robustness is not explained by mammography exposure alone. DINOv3 remains a competitive vision-only baseline, and mammography-adapted pretraining does not consistently improve generalization. Dataset-level analysis further shows that even leading models show heterogeneous performance across datasets. Feature-space inspection reveals that useful representations can preserve clinical signal while retaining dataset and acquisition structure. These findings highlight dataset-level OOD evaluation as a central criterion for assessing mammography representations. Our code is publicly available: https://github.com/biomedia-mira/mammo-ood.

Comparison of Loss Functions for Robust Deep Learning-based Echocardiography Segmentation when Learning with Partially Labelled Data from Multiple Domains

Echocardiography is the first imaging modality used for assessing cardiac function, and accurate segmentation of cardiac structures is essential for deriving biomarkers. However, the development of effective automated segmentation models for multiple cardiac structures is challenged by the difficulty of training on datasets from different sources that are often partially-labelled. This study aims to address this challenge by evaluating the performance of three loss functions - adaptive categorical cross entropy (aCCE) loss, marginal loss, and the adaptive binary cross entropy (aBCE) loss - in handling partially-labelled data. We conduct a comprehensive comparison of these loss functions across multiple scenarios and network architectures: intra-domain and inter-domain tasks, with both single and multiple partial-labels, and varying proportions of fully-labelled to partially-labelled data. Our experiments reveal that all three loss functions exhibit strong performance in intra-domain segmentation tasks, effectively handling label variations within the same domain. For inter-domain tasks, where models are trained on datasets with a domain shift, the aBCE and marginal losses show superior performance when dealing with the case of one label being missing from some training examples. In scenarios involving more than one label being missing, marginal loss outperforms the other methods, demonstrating its robustness in such complex conditions. These results highlight the strengths of each loss function depending on the labelling scenario, emphasizing the importance of selecting the appropriate loss function to optimize model performance. This study represents the first investigation of techniques for handling partially-labelled data from multiple different domains in echocardiography segmentation and provides a comprehensive comparison of loss-based solutions.