ADMIL: Attention-Distilled Multiple Instance Learning for Selective Foundation Model Inference in Pathology

Attention-based multiple instance learning (ABMIL) using pathology foundation model embeddings is effective for slide-level tasks, but exhaustive inference requires applying a large image encoder to every foreground tile despite the subsequent attention distribution often concentrating over a small subset of informative regions. We introduce ADMIL (Attention-Distilled Multiple Instance Learning), a selective-compute framework that distills an ABMIL teacher's attention into a lightweight tile-selection model, PriorNet. Using an EfficientNet architecture, PriorNet learns the teacher attention distribution from raw tile pixels with KL divergence; at inference, it scores the foreground pool, selects the top-K tiles, and invokes the expensive foundation model only on that subset before a selected-bag ABMIL student predicts the slide label. Across BRACS, PANDA, and CAMELYON16, ADMIL matches full-teacher headline performance at K=4, 8, and 128 tiles, respectively, avoiding >98% of foundation model (Virchow2) tile embeddings and model inference FLOPs. Random and teacher-attention oracle controls show that this result depends on task-relevant selection rather than tile-count reduction alone. Quantitative and qualitative analyses suggest that PriorNet recovers the teacher's tile ordering with high fidelity while focusing on task-relevant morphological regions. ADMIL shows that nearly all expensive tile encodings can be removed without sacrificing slide-level performance, providing a potential path for more efficient deployment in clinical settings where latency and compute costs are key considerations.

Sterilizable Scene Graph Generation for Operating Rooms

Scene graph generation from surgical video enables a holistic and structured understanding of surgical scenes by modeling objects and their semantic relationships. Despite recent advances, state-of-the-art approaches rely on large, parameter-heavy deep learning models that are impractical for deployment in the operating room (OR) due to hardware footprint, hygiene constraints, latency, and data privacy concerns. To the best of our knowledge, this is the first scene graph generation method built on NCAs and the first NCA framework capable of learning structured representations. We introduce SG-NCA, a lightweight scene graph generation framework based on Neural Cellular Automata (NCA), designed for inference in fanless devices critical for OR hygiene protocols. SG-NCA is the first scene graph generation combining NCA-based multiclass segmentation for efficient object detection and feature extraction with a lightweight relation predictor. We evaluate SG-NCA on videos of cataract surgery and cholecystectomy, demonstrating performance comparable to established baselines while requiring 55x fewer parameters. We showcase deployment on fanless edge devices better suited for the OR and demonstrate downstream applications such as surgical video captioning, highlighting SG-NCA's potential for affordable, privacy-preserving, and OR-ready intraoperative scene understanding.

EA-LiteUNet: An Edge-Adaptive and Resource-Efficient U-Net for Boundary-Sensitive Dermoscopic Image Segmentation

Accurate boundary delineation remains a persistent challenge in dermoscopic image segmentation because of blurred lesion margins, heterogeneous textures, and complex background artifacts. From a signal-processing perspective, lesion boundaries represent high-frequency components that are highly susceptible to aliasing, noise amplification, and information loss. Consequently, repeated downsampling and feature transformations in conventional convolutional architectures often lead to severely degraded boundary representations. To address these limitations, we propose EA-LiteUNet, an edge-adaptive and computationally efficient U-Net variant specifically designed for boundary-sensitive medical image segmentation. The architecture integrates three core mechanisms: (1) boundary-aware representation learning to suppress aliasing and preserve high-frequency structural details; (2) attention-guided feature modulation to selectively enhance boundary-relevant responses across multi-scale features; and (3) a resource-adaptive inference strategy to dynamically balance segmentation accuracy and computational efficiency. Extensive evaluations across three public dermoscopic datasets demonstrate that EA-LiteUNet consistently achieves superior boundary precision. Specifically, on the ISIC 2018 dataset, the method significantly reduces the 95% Hausdorff Distance (HD95) to 12.89 pixels while maintaining a robust Dice score of 92.08%. Notably, this strong performance is achieved with an ultralightweight configuration of merely 0.29M parameters and 1.17 GFLOPs. Ablation studies further validate the complementary effects of these components, confirming their contribution to enhanced boundary fidelity and stable optimization.

ZIPBrain: Can EEG Foundation Models Be Faster, Locally Deployable, but Accurate?

This work investigates whether Electroencephalograph (EEG) foundation models (EFMs) can be made faster and locally deployable without sacrificing accuracy. EEG foundation models are a major trend, offering strong general-purpose representations. However, their computational burden grows quadratically with input length, hindering deployment on resource-constrained scenario, particularly for real-time clinical monitoring. EEG's low SNR further suggests many of these tokens are redundant and compressible with little accuracy cost. We propose ZIPBrain, a novel redundancy-aware EEG token pooling module that leverages this low-SNR characteristic to reduce token count. Given a token sequence, ZIPBrain partitions tokens into redundant and unique groups, then merges each redundant token with its most similar counterpart in the unique group. Furthermore, ZIPBrain serves as a training-free, plug-and-play module that seamlessly integrates into standard Transformer encoders with negligible computational overhead. Extensive experiments across multiple EEG foundation models show ZIPBrain's strong versatility, achieving 1.3%-10.5% average improvement over baselines, while reducing wall-clock inference time by 32.7% (up to 41.8% with CUDA Graph) compared to the original EEG foundation models.

SecondOpinion: Anatomy-Aware Gated Reasoning for Efficient Medical Image Analysis

Deep learning models for medical image analysis typically apply a fixed amount of computation to every input, regardless of case difficulty. Anatomy-guided dual-stream architectures have been shown to improve diagnostic performance, but they evaluate both streams unconditionally, even on cases a single stream could already resolve confidently. We propose SecondOpinion, a framework in which a fast primary stream processes every case, while a second, anatomy-guided stream is invoked only when GateKeeper, a gating mechanism trained explicitly as a binary correctness classifier, judges that the primary stream's prediction needs additional scrutiny, much as a clinician might seek a second opinion on a difficult case. When activated, the two streams are combined through a lightweight cross-attention fusion module. We evaluate SecondOpinion on a unified five-class chest X-ray dataset and a pelvic fracture dataset, the latter including a held-out, harder subset of fractures that are invisible on X-ray but confirmed via CT. SecondOpinion matches or exceeds prior state-of-the-art performance on both tasks, while activating its anatomy-guided stream on only 9.23% of chest X-ray cases, rising to 24.12% on visible fractures and 45.71% on invisible fractures, an activation rate that tracks task difficulty directly. These results suggest that supervising a gating signal toward correctness, rather than relying on unsupervised confidence, allows a model to allocate anatomical reasoning where it is actually needed.

RadYOLO: Computationally Efficient 3D Object Detection and Segmentation in CT and MRI

Object detection and segmentation in three-dimensional medical images is a very active area of research. However, most proposed deep learning models carry a high computational cost, and only few aim to be broadly applicable, achieve high detection performance, and remain fast to execute on resource-constrained hardware. To address this gap, we present RadYOLO, a 3D extension of YOLO11 tailored to medical images. We compare it with nnU-Net and nnDetection on five datasets comprising CT and MRI data with varying object sizes and prevalence. RadYOLO's detection performance surpasses that of nnDetection on four of five datasets and is comparable on one. Compared to nnU-Net, RadYOLO performs better on lesion detection tasks, while nnU-Net excels at detecting large organs when precise localization is required. When rough object localization is sufficient, RadYOLO matches or outperforms nnU-Net on all five datasets. Regarding inference time, RadYOLO is 8-46x faster than nnU-Net on a GPU. Compared to nnDetection the speedup is even higher. When executed on a CPU, RadYOLO's inference runs within seconds (still faster than nnU-Net on a GPU) offering a significant advantage for clinical and edge-device deployment. RadYOLO repository: https://github.com/FraunhoferMEVIS/RadYOLO

Adaptive Routing for Efficient Diffusion Transformer-Based PNI Prediction

Perineural invasion (PNI) is a critical prognostic factor in cholangiocarcinoma. However, its preoperative prediction from magnetic resonance imaging (MRI) remains challenging due to subtle imaging features that extend beyond tumor boundaries into surrounding regions. Conventional convolutional neural networks are limited in capturing long-range spatial dependencies. Transformer-based architectures improve global modeling of volumetric MRI by aggregating spatially distributed contextual cues, yet capturing subtle and noise-sensitive patterns in peritumoral regions remains challenging. Diffusion-based classifiers offer an alternative formulation by leveraging denoising-based class scoring to better capture such subtle patterns. However, these approaches introduce substantial computational overhead due to the combination of transformer-based modeling and iterative denoising processes. To address these challenges, we formulate PNI prediction as a diffusion-based classification problem and implement the denoising network using a transformer-based representation. To improve computational efficiency, we introduce adaptive routing across attention heads, spatial tokens, and MLP width. Experimental results demonstrate that the proposed approach achieves an AUC of 0.731 with 257.57 GFLOPs.

Towards Accurate and Fast Clinical Body Composition: A Resource-Efficient Hierarchical Segmentation Framework for Multi-Source CT

Background: Automated 3D segmentation of muscles and adipose tissue from CT is vital for body composition analysis, but multi-source data heterogeneity and high CPU memory demands hinder clinical deployment. Methods: We propose a coarse-to-fine hierarchical framework to segment ten tissue structures. Efficiency is optimized using Dynamic Spacing and Anisotropic Patching, a Group Inference mechanism for low-memory sliding-window processing, and Topology-Aware Asymmetric Resampling for fast post-processing. Results: The framework was trained on 1,558 CT volumes from seven public and two private datasets, and evaluated on an independent test cohort (N=105), per-structure Dice coefficients ranged from 0.924 to 0.982. Eight major structures met the +-10% relative error clinical acceptance limit. On a 12-core CPU workstation, the GPU-free pipeline averaged 44.5 seconds per volume with 4.73 GB peak memory. Conclusion: This framework balances accuracy and efficiency, enabling robust, large-scale body composition analysis on standard CPU workstations.

LRMIL: Efficient Low-Resolution Multiple Instance Learning via High-Resolution Knowledge Distillation for Whole Slide Image Classification

Multiple instance learning (MIL) has become a standard paradigm for whole slide image (WSI) analysis in digital pathology, as it enables slide-level prediction without dense annotations. Existing MIL methods typically rely on exhaustive extraction and encoding of high-resolution patches. However, this practice suffers from two critical limitations in real-world clinical settings: it struggles to capture global visual cues at lower magnifications, and incurs substantial computational overhead due to the massive number of high-resolution patches per slide. To address these limitations, we propose an efficient low-resolution multiple instance learning (LRMIL) framework that transfers high-resolution knowledge to low-resolution representations. LRMIL adopts a two-stage distillation strategy. First, patch-level cross-resolution distillation aligns low-resolution patch embeddings with high-resolution representations. Second, slide-level knowledge distillation trains a low-resolution student MIL model under both slide-level supervision and teacher guidance. At inference time, LRMIL operates exclusively on low-resolution patches, substantially reducing data preprocessing and computational cost. Extensive experiments on multiple WSI benchmarks demonstrate that LRMIL consistently outperforms state-of-the-art MIL methods while achieving more efficient inference. These results highlight LRMIL as a practical and scalable solution for WSI analysis in clinical pathology.

SpineContextResUNet: A Computationally Efficient Residual UNet for Spine CT Segmentation

Automated segmentation of the vertebral column in Computed Tomography (CT) scans is a prerequisite for pathological assessment and surgical planning. However, state-of-the-art methods, particularly those based on Transformers or large-scale ensembles, demand substantial GPU resources, creating a barrier for clinical adoption in resource-constrained environments or on edge devices. To address this, we introduce SpineContextResUNet, a computationally efficient 3D Residual U-Net designed for rapid spinal localization. Our architecture integrates a lightweight Context Block that employs parallel multi-dilated convolutions to capture long-range anatomical dependencies without the high latency of Recurrent Neural Networks (RNNs) or the memory overhead of Self-Attention mechanisms. Extensive validation on two public benchmarks, VerSe2020 and CTSpine1K, demonstrates that our model achieves a Dice score of 88.17% and 88.13% respectively. To evaluate performance under strict hardware constraints, we compared our model against a bottlenecked SwinUNETR scaled to match our ~1.7M hardware footprint. While the constrained Transformer suffers severe performance degradation due to a lack of spatial inductive biases in a limited-data regime, our CNN-based approach successfully maintains high accuracy. Crucially, heavy baselines like TotalSegmentator fail due to memory exhaustion on commodity hardware (Intel Core i5, 8GB RAM), our model performs robust inference, making it a viable solution for point-of-care diagnostics and deployment on edge platforms like the Nvidia Jetson Orin Nano.