CMRVision: A Foundation Model for Cardiac MR Image Analysis

Cardiac magnetic resonance (CMR) imaging provides complementary information on cardiac anatomy, function, and tissue characterization across multiple sequences and views. In this work, we investigate foundation model pretraining for 2D CMR and introduce CMRVision, a CMR-specific foundation model trained using DINOv3-style self-supervised learning on a multi-center, multi-sequence cohort of 36 million CMR images. We systematically evaluate architectural and training design choices for domain-specific pretraining. CMRVision is evaluated on two downstream tasks: multi-task segmentation across cine, late gadolinium enhancement (LGE), and mapping sequences, and cine view classification. Our experiments show that CMR-specific pretraining, smaller patch sizes, and patch-level objectives consistently improve downstream performance. Across a multi-task segmentation benchmark, CMRVision achieved the strongest overall performance, outperforming prior natural-image (NI), medical-image, supervised, and CMR foundation model baselines. Improvements were modest but consistent across structures and sequences, with Dice scores ranging from 0.940-0.967 for LV and 0.855-0.905 for myocardium, and reaching 0.929 for RV, 0.920 for LA, and 0.931 for RA. The largest gains were observed for myocardium segmentation in LGE and mapping images. In a zero-shot segmentation task on unseen LGE long-axis views, the model achieved an average Dice score of 0.692, demonstrating cross-view generalization. For cine view classification, CMRVision achieved the highest average accuracy (0.906), compared to prior methods reported in the literature. These results highlight the potential of CMRVision to support robust and generalizable cardiac MRI analysis across multiple sequences and views.

FTU-Seek: Foundation Model-Guided Hard-Negative Learning for Sparse Functional Tissue Unit Segmentation

Functional tissue units (FTUs), including tertiary lymphoid structures (TLSs), blood vessels, and glands, encode localized immune, vascular, and epithelial organization in histopathology. Accurate quantification of these structures is important for studying tissue architecture and disease-associated tissue organization. However, FTUs are frequently sparse, heterogeneous, and surrounded by large amounts of morphologically similar background tissue, making automated segmentation in whole-slide images (WSIs) challenging. We therefore developed FTU-Seek, a pathology foundation model-guided framework that treats morphology-aware negative-patch selection as a key component of sparse FTU segmentation. FTU-Seek uses frozen multi-depth features from the UNI pathology foundation model to train a patch-level classifier that distinguishes FTU-containing from FTU-absent tissue. Target-absent patches are subsequently ranked according to their predicted target-containing probabilities, and the highest-scoring hard negatives are selected through a static Top$K$ strategy to construct compact segmentation training sets. The framework was evaluated using five-fold cross-validation and internal test cohorts across TLS, blood-vessel, and gland segmentation tasks, with an additional independent 30-WSI held-out cohort for TLS. Positive-only, all-tissue, random-negative, and matched random Top$K$ sampling strategies served as comparators. Segmentation-derived phenotypes were further explored in external TCGA cohorts.

The MYOSAIQ Challenge: Myocardial Segmentation with Automated Infarct Quantification

Late gadolinium enhancement (LGE) cardiac magnetic resonance (MR) imaging is the modality of choice to assess myocardial infarction (MI) lesions. Nowadays MI volume quantification is not performed routinely in clinical practice. Numerous deep learning (DL) methods have been developed to automate the segmentation of the myocardium and infarct regions. However, most studies rely on relatively small datasets which typically undergo pre-processing steps to standardize images and focus on a specific phase of myocardial infarction following reperfusion therapy. These limitations have impeded the development of models that are generalizable across diverse conditions and thus suitable for routine clinical use. To advance research and establish benchmarks in generalizable learning for myocardial infarct quantification, this paper presents findings from the Myocardial Segmentation with Automated Infarct Quantification (MYOSAIQ) challenge. The dataset set up for the challenge combines 439 CMR volumes from two multicenter clinical trials, with representative data acquired in acute and chronic phases after acute MI. Data were acquired in 16 centers using MRI scanners from three different vendors. Six teams participated until the end of the challenge, employing various baseline models, data augmentation techniques, and confidence strategies. To enhance the significance of this study, we compare the challengers' results with those of fine-tuned foundation models. Our results indicate that well-designed UNet-based techniques outperform fully automatic foundation models for LGE MR segmentation. While the best methods achieve high-quality and stable delineations of the left ventricle and myocardium under various conditions, they remain improvable in accurately segmenting infarct regions.

Evaluating the Effects of Inter-Observer and Model Variability on Radiological Peritoneal Cancer Index Assessment

Deep learning segmentation models are often evaluated using geometric metrics such as Dice, HD95, and ASD, yet it remains unclear to what extent improvements in these metrics translate into clinically meaningful changes in downstream decision-making. The metric-to-decision gap is examined using radiological Peritoneal Cancer Index (rPCI) region segmentation on contrast-enhanced CT, where a consensus definition provides anatomically grounded 3D regions and the clinically used PCI 20 threshold enables decision-level evaluation. Inter-observer variability is quantified across four experts on ten abdominal CT scans, and a published nnU-Net based rPCI segmentation model is benchmarked against this human reference using Dice, HD95, and ASD across all 13 regions. To relate geometric differences to clinical impact, a probabilistic peritoneal metastasis simulation is implemented on majority-vote rPCI maps, propagating region-boundary variability into variability of derived (r)PCI scores and classification at the PCI 20 cutoff. Observers showed high agreement (mean Dice $0.87$), while the model matched human performance in most regions but deviated more in regions 4, 8, and the small-bowel regions (9-12). Across simulations, score differences were typically small (mean $Δ$rPCI $\approx 0.3$-$0.6$) for both observers and the model, and decision flips occurred predominantly when the reference score was near 20. These results suggest that rPCI-derived scoring is generally robust to typical segmentation variability, while highlighting borderline cases as the main setting where expert review remains essential.

UniFLM: United Segmentation and Measurement on Fetal Limb Ultrasonic Image

Prenatal ultrasound examination is crucial for assessing fetal limb development and detecting congenital anomalies. However, existing artificial intelligence models often overlook fetal lethal skeletal dysplasias due to the lack of high-quality annotated data and a unified framework for multiple long bones. Moreover, generic segmentation models struggle with the inherent noise and semantic gaps in ultrasound images. To address these challenges, we construct the Fetal Limb Bones (FLB) dataset, comprising high-quality annotations for the humerus, femur, tibia-fibula, and radius-ulna. Furthermore, we propose UniFLM, a unified framework for automatic cross-plane segmentation and measurement. UniFLM incorporates a Semantic-Aware Skip Connection module to bridge the semantic gap between encoder and decoder features, and a Positive Sampling strategy to adaptively filter noise and extract essential semantic information. Finally, a Point Regression Mapping module is introduced to learn clinician annotation patterns for precise bone length measurement. Extensive experiments conducted on the FLB dataset demonstrate that the proposed UniFLM achieves superior accuracy and enhanced generalization capabilities in fetal long bone assessment compared to current state-of-the-art models.

From Reasoning to Pixels: Grounded Medical Multimodal LLMs for VQA and Segmentation

Although Multimodal Large Language Models (MLLMs) have demonstrated impressive performance in Medical Visual Question Answering (Med-VQA), their reliance on global image features often lacks precise pixel-level grounding, thereby limiting clinical trustworthiness. To bridge the semantic gap between high-level clinical reasoning and spatial localization, we propose \textsc{\textsc{MedREAL}} (\textbf{Med}ical \textbf{RE}asoning-driven \textbf{A}nswering and \textbf{L}ocalization), a unified framework that seamlessly aligns linguistic reasoning with spatial grounding. Specifically, \textsc{MedREAL} introduces \textbf{S}eg \textbf{A}nchored \textbf{R}easoning \textbf{P}ooling (SARP) to distill task-relevant semantic evidence directly from \texttt{[SEG]} tokens within the MLLM's hidden states. Furthermore, a \textbf{R}easoning-to-\textbf{V}isual (R2V) fusion mechanism is proposed to effectively inject these reasoning-aware features into a segmentation pipeline for accurate mask decoding. To facilitate this paradigm, we construct MedRAVS-13K, a comprehensive dataset comprising 13,824 expertly validated samples across four diverse imaging modalities. Extensive experiments demonstrate that \textsc{MedREAL} significantly outperforms state-of-the-arts, achieving 68.49\% gIoU and 70.47\% cIoU on benchmark evaluations. By generating evidence masks that are strictly consistent with textual diagnoses, \textsc{MedREAL} provides a robust, interpretable framework for reasoning-driven medical image analysis.

LUTSeg: A Longitudinal Multi-Expert Dataset for Ulcer Tissue Segmentation

Quantifying wound tissue composition is essential for monitoring chronic ulcer progression and guiding treatment decisions. However, pixel-level annotations are costly, and multi-tissue wound datasets remain scarce, particularly for neglected diseases such as leprosy. We introduce LUTSeg, a longitudinal chronic ulcer dataset comprising 141 images from 39 patients with wound masks and five tissue categories annotated by five expert clinicians, including a multi-expert gold-standard subset for inter-rater agreement analysis. To establish an initial benchmark for LUTSeg, we further propose TiSage, a semi-supervised tissue segmentation framework that integrates multi-scale semantic priors from a frozen medical vision-language model within a teacher-student architecture. We evaluate TiSage on LUTSeg and DFUTissue, showing improvements over supervised and semi-supervised baselines in most low-label settings. Code & data: https://github.com/carlosh93/TiSage

Model Effect or Label Effect? Refined Annotations and a Human-Referenced Benchmark for Pulmonary Embolism Segmentation

Purpose: To quantify how evaluation annotations influence measured pulmonary embolism (PE) segmentation performance relative to model training changes, and to establish a human-referenced framework. Materials and Methods: This retrospective study screened 166 voxel-annotated CT pulmonary angiography cases from CADPE (n=91), FUMPE (n=35), and READ (n=40); 149 were included. A primary rater annotated PE by protocol, and a senior thoracic radiologist reviewed and revised all segmentations. Three additional raters at three centers annotated a 15-case subset. The label effect was measured by evaluating two pretrained nnU-Net models (nnU-Net-A, nnU-Net-B) against original and refined annotations. The model effect was measured by comparing the same architecture trained on different dataset combinations with annotations fixed. The benchmark model (nnPE) was trained with leave-one-dataset-out and pooled five-fold cross-validation. Four metric categories were analyzed with case-paired Wilcoxon signed-rank tests, Benjamini-Hochberg correction, and bootstrap 95% CIs. Results: Changing only the annotation increased mean DSC by 0.143 (0.122-0.166) for nnU-Net-A and 0.188 (0.163-0.213) for nnU-Net-B (both P < .001), whereas changing training-dataset composition changed DSC by 0.028. The label effect exceeded the model effect on CADPE and FUMPE and was 0.045 on READ. Within-mask attenuation SD fell in all three datasets after re-annotation (all P < .001). nnPE reached DSC 0.72 +/- 0.22 on pooled cross-validation but scored below all four annotators across 52 paired comparisons (all corrected P < .05). Conclusion: Evaluation annotations affected measured PE segmentation performance at least as much as model training choices. A human-referenced evaluation framework is publicly available for future study.

Spatiotemporal Distillation via Recurrent Bottlenecks for Aortic Tracking

Cardiac cine-MRI serves as a direct visual indicator of cardiovascular hemodynamics by capturing the continuous wall motion of the aorta. Quantifying these dynamic structural changes across the cardiac cycle is essential for measuring aortic distensibility, a primary marker of arterial stiffness. However, standard 2D segmentation networks focus on each frame independently. Consequently, when rapid systolic flow temporarily obscures the aorta's boundaries, this lack of continuous context results in frame-to-frame tracking dropouts and boundary inconsistencies. Spatiotemporal ($2\text{D}+t$) networks can enforce temporal consistency across the sequence but suffer from a scarcity of expert annotations. To address this, we present a semi-supervised spatiotemporal ($2\text{D}$ to $2\text{D}+t$) knowledge distillation framework exploiting the cardiac cycle. The framework distills a spatial teacher's expertise into a spatiotemporal student network by executing a dynamic latent interception, pairing a recurrent spatiotemporal bottleneck with a residual spatial bypass. Our model selection strategy applies a baseline validation threshold ($\text{DSC} \ge 0.50$) prior to selecting the epoch that maximizes anatomical consistency. This strategy enables the spatiotemporal student model to achieve superior surface tracking accuracy ($\text{NSD@1mm} = 92.3\% \pm 0.2\%$) and high structural reliability ($\text{Frac}_{2\text{CC}} = 99.2\% \pm 0.6\%$), reducing population-wide structural anomalies by over 56\% compared to a 2D nnU-Net baseline.

Image-Conditioned Diffusion Models for Quality Assurance of Organ-at-Risk Segmentations in Radiotherapy

Accurate organ-at-risk segmentation is essential for radiotherapy planning, but reviewing segmentations is time-consuming and subjective. We investigate normative modelling for segmentation error detection in head-and-neck CT, comparing a VAE framework with an image-conditioned segmentation diffusion model. Models were evaluated on RADCURE brainstem and spinal cord segmentations using simulated boundary and width perturbations. Error detection was assessed using the Dice similarity coefficient and the Distance to Agreement (DTA) between the input and reconstructed segmentations. While both models detected some simulated errors, regional DTA showed that the diffusion model localised subtle boundary errors more consistently. These results support image-conditioned diffusion reconstruction as a promising framework for localised, anatomy-aware segmentation QA.

CFB-GBM v2.0: An Augmented Longitudinal Dataset for Multi-Modal Glioblastoma Segmentation, Radiomics, and RANO Progression Tracking

Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a median overall survival of 15 months. Longitudinal, multi-modal imaging datasets with comprehensive clinical and treatment data are essential to support the development of reproducible computational methods for treatment response prediction, disease progression modelling, and personalized medicine. We present CFB-GBM v2.0, an extension of our previously released CFB-GBM dataset comprising 264 GBM patients treated according to the standard Stupp protocol. The primary contribution of this release is the completion of Gross Tumour Volume (GTV) delineations across all available timepoints ($t_0$, $t_1$ and $t_2$), increasing the overall GTV completion rate from 35% to 97%. This was achieved using a nnU-Net model pre-trained on BraTS 2021 and fine-tuned on CFB-GBM ground-truth contours, with the generated segmentations validated by five radiation oncologists. From these longitudinal GTV annotations, volumetric RANO 2.0 response category labels were derived for all available temporality pairs ($t_0 \rightarrow t_1$, $t_0 \rightarrow t_2$ and $t_1 \rightarrow t_2$). To further ease dataset usability and reproducibility, brain masks computed with HD-BET and pre-computed radiomic features extracted with PyRadiomics are provided for each patient timepoint and MRI modality. Additionally, the WHO classification guideline (2016 vs. 2021) applicable to each patient's diagnosis is now explicitly documented. CFB-GBM v2.0 is publicly available on The Cancer Imaging Archive (TCIA) at https://www.cancerimagingarchive.net/collection/cfb-gbm .

Comprehensive Benchmarking of Deep Learning Architectures for Lung Cancer Histopathology

Lung cancer remains the leading cause of cancer-related mortality worldwide, while histopathological diagnosis is often affected by inter-observer variability and the substantial workload associated with manual slide examination. Although deep learning has shown considerable potential in computational pathology, comprehensive benchmarks that integrate tissue classification and region segmentation within a unified analytical framework remain limited. This study presents a two-stage deep learning framework for multi-class tissue classification and pixel-level histopathological region segmentation, accompanied by a systematic comparison of state-of-the-art architectures at each stage. For tissue classification, six models, a custom convolutional neural network, VGG16, DenseNet, MobileNetV3, a custom Vision Transformer, and YOLO11, are evaluated on a combined dataset of 39,000 images derived from LC25000 and LungHist700. The models distinguish between adenocarcinoma, squamous cell carcinoma, and normal lung tissue. YOLO11 achieves the best classification performance, with an accuracy of 98.38%, a five-fold cross-validation accuracy of 98.21 +/- 0.35%, and a macro F1-score of 0.98. For region segmentation, U-Net, ResNet-encoder U-Net, DeepLabV3+, and YOLO11-seg are evaluated using the GlaS gland segmentation benchmark. DeepLabV3+ obtains the highest Intersection over Union of 0.80 and a Dice score of 0.89, while YOLO11-seg achieves a comparable Intersection over Union of 0.79 using approximately 14x fewer parameters. The best-performing classification and segmentation models are subsequently integrated into an end-to-end framework, providing an accurate, computationally efficient, and reproducible baseline for automated histopathological image analysis.

In Defense of OCTA: The Reconstruction-Utility Gap in OCT-to-OCTA Synthesis

Optical coherence tomography angiography (OCTA) images retinal blood flow, giving capillary-perfusion and foveal-avascular-zone biomarkers that grade diabetic-retinopathy ischemia. Because OCTA hardware is less common than structural OCT, recent work synthesizes it from OCT, reporting strong reconstruction (3D PSNR > 31 dB, SSIM > 0.9). We ask not whether the synthetic image looks similar, but whether it supports the measurements OCTA is acquired for. A frozen real-OCTA segmenter, applied as a probe to two synthesizers (XOCT, TransPro), shows downstream Dice falling with structural fineness: large vessels survive (0.862 -> 0.831) while the fine capillary network collapses (0.798 -> 0.635, five times the large-vessel loss; paired Wilcoxon p < 1e-3), TransPro worse throughout. A matched-blur control shows this detail is fabricated, not blurred. Retrained on a private Spectralis dataset, neither synthesizer reproduces the neovascular lesion (qualitative, n=3). Reconstruction fidelity is not clinical utility; we establish downstream-task fidelity as the evaluation OCT-to-OCTA synthesis needs.

Auditable agentic AI for evidence-grounded thyroid ultrasound diagnosis and reporting

Thyroid ultrasound diagnosis requires coordinated lesion localization, measurement, risk stratification and reporting, yet most AI systems address these tasks in isolation and provide limited support for clinical review. We present ThyroidXAgent, a clinician-interactive agentic AI system that coordinates specialized diagnostic tools and stores their outputs as an auditable case-level evidence record. The system was developed using OpenThyroidDB, a multicentre, multitask resource integrating approximately 0.3 million ultrasound images and 24,000 paired reports, and was evaluated on 28,458 non-overlapping test cases, including 8,721 cases from 35 centres in the private NHC-MISD-TUS cohort. Across heterogeneous datasets, ThyroidXAgent achieved a mean Dice score of 87.21 percent for nodule segmentation and a mean AUROC of 0.9466 for benign-malignant classification. The same workflow supported lymph-node metastasis prediction and follicular versus papillary thyroid carcinoma classification, with AUROCs of 0.864 and 0.805, respectively. For report generation, evidence-grounded assembly outperformed multimodal language-model baselines across three cohorts. ThyClinScore, a lesion-level clinical semantic metric introduced here, showed the strongest correlation with a location-aware language-model judge. ThyroidXAgent improved physician classification accuracy, increased report diagnostic consistency from 70.3 percent to 86.2 percent, and reduced segmentation and reporting time by 35.9 percent and 27.4 percent, respectively. These findings support auditable, clinician-correctable agentic AI for thyroid ultrasound diagnosis and reporting.

MedUP: Awakening Unified Understanding and Perception in Medical Vision-Language Models

Medical Vision-Language Models (Med-VLMs) excel at verbalizing visual content, yet precise visual perception, segmentation, and grounding remain challenging. Existing approaches either verbalize regions as coordinate strings or rely on external modules that decouple perception from understanding, creating representation gaps for region-language alignment. We present MedUP, a Med-VLM that natively unifies perception and understanding within a shared token space. At its core lies UniMedTok, a region tokenizer that encodes masks as discrete tokens in the LLM vocabulary, enabling the model to seamlessly interleave mask tokens with text. We curate UniMed-Train, a 1.84M-instance corpus spanning text-guided segmentation, region-grounded understanding, medical VQA and CoT-based segmentation, and introduce UniMed-Bench for unified evaluation. Extensive experiments show that MedUP outperforms native, agentic, and dual-decoder Med-VLMs across all tasks while remaining competitive with specialist segmentors, demonstrating the strong potential of unified understanding and perception modeling.

UPolarSQ: Polar Representation Learning for Optic Disc and Peripapillary Atrophy Segmentation and Quantification in Fundus Photographs

Myopia-induced posterior-pole remodeling is frequently accompanied by Optic Disc (OD) deformation and Peripapillary Atrophy (PPA), both of which provide clinically relevant structural biomarkers. In Cartesian fundus images, however, PPA often appears as an irregular and partially visible crescent adjacent to the OD, leading to fragmented segmentation and post-processing-dependent quantification. We propose UPolarSQ, a unified polar-domain framework for OD/PPA segmentation and biomarker quantification in myopic fundus images. UPolarSQ first maps an OD-centered region of interest into polar coordinates, where OD and PPA boundaries can be represented as radial profiles. It then employs UPolarSeg, a U-Net-based segmentation network enhanced with a Radial-Angular-Decoupled Module and boundary-aware auxiliary supervision to model anisotropic polar features and radial boundary transitions. Clinical biomarkers, including disc shape and PPA-width-related measurements, are deterministically extracted from the predicted polar masks, aligning segmentation and quantification within a shared geometric representation. Experiments on internal and external cohorts demonstrate that UPolarSQ improves OD/PPA segmentation and supports reliable polar-native biomarker estimation for myopic analysis.

Anatomically Consistent Cross-Contrast Super-Resolution of Anisotropic Brain T2w MRI

T2-weighted (T2w) brain MRI provides fluid-sensitive soft-tissue contrast that is important for neuro-oncology and radiotherapy planning. However, T2w scans are acquired with anisotropic voxels and appear blurred or stair-stepped on coronal and sagittal views, which obscures small structures and weakens any downstream 3D analysis. We propose VIPP-SR (View-Independent Patched Projection Super-Resolution), a cross-contrast guided super-resolution framework that restores the inter-plane resolution of an existing anisotropic T2w volume without an isotropic ground-truth T2w. VIPP-SR first trains a view-independent patched generator (VIP-GAN) to learn local T1c-to-T2w anatomical correspondence from high-resolution axial slices. The trained generator is then applied to axial, coronal, and sagittal views of the T1c volume to generate three orthogonal T2w estimates. Shape-preserving patching and deepest-skip removal reduce view-specific shortcuts, thereby constraining the generator to learn patch-local representations and enabling the zero-shot inter-plane transfer. Central to VIPP-SR, a projection-based optimization then enforces anatomical consistency across the three view-specific volumes, fusing them by balancing inter-plane self-consistency against per-view data fidelity. The generator is trained on BraTS-MET and evaluated on both the held-out BraTS-MET testing set and the BraTS-GLI cohort without retraining, assessing the cross-cohort generalizability. The results validate that VIPP-SR improves downstream segmentation over the real anisotropic T2w baseline, raising mean-label Dice from 0.330 to 0.465 on BraTS-MET and, zero-shot, from 0.473 to 0.563 on BraTS-GLI and ablation studies identify inter-plane self-consistency as the main source of the gain.

Foundation Models Adaptation for Multi-View Multi-modal Cardiac MRI Segmentation and Direct Ejection Fraction Estimation

Foundation models have shown strong transferability in cardiac MRI (CMR), but their effectiveness for heterogeneous multi-view and multi-sequence CMR analysis remains unclear. In this work, we explore the effectiveness of fine-tuning and combining different CMR foundation models for the Universal Multi-Sequence, Multi-Center and Multi-View CMR Segmentation (CMR-Multi) Challenge. CineMA was fine-tuned for cine and late gadolinium enhancement (LGE) segmentation across short-axis and long-axis views. For direct left-ventricular ejection fraction (LVEF) estimation, we used two recent frozen CMR foundation models to extract embedding vectors that were then combined using attention-based multiple-instance learning for LVEF regression. In the challenge validation set, cine segmentation achieved Dice scores of 0.862, 0.883, and 0.902 for short-axis, two-chamber and four-chamber cine MRI, respectively. LGE segmentation achieved Dice scores between 0.621 and 0.846 across views. The direct LVEF regression model achieved an MAE of 4.96 percentage points and a Pearson correlation of 0.91. These results indicate that foundation models can be effectively adapted and combined for multi-view CMR analysis, while accurate LGE scar segmentation remains a challenging task.

TLNM: Externally Validated Tooth Detection, Numbering and Segmentation from Smartphone Photographs Using Mask R-CNN

Oral health issues affect billions globally, but the cost and limited access to professional dental care hinder preventive oral healthcare. Research relies on clinical-grade radiographs or intraoral camera images, unavailable for public self-screening. This study introduces a tooth localisation and numbering model for smartphone photographs. We developed a customised Mask Region-based Convolutional Neural Network (Mask R-CNN) pipeline trained on 1,272 annotated smartphone images. To address variability in patient-generated health data, the pipeline incorporates two domain-informed mechanisms: a masked gray-world white-balancing algorithm to mitigate artificial colour casts and an anatomically constrained detection layer to enforce structural validity and suppress false positives. Evaluation comprised four stages: internal held-out testing, independent external testing, a descriptive ablation study, and fold-based training stability analysis using the same internal test set. On the internal test set, the model achieved an instance-mask AP@50 of 0.818, class-aware PQ of 0.780, and operational F1 of 0.884. Training stability showed limited between-model variation: across ten runs, instance-mask AP@50 had a standard deviation of 0.009. On the external dataset, the model achieved an instance-mask AP@50 of 0.901, class-aware PQ of 0.832, and operational F1 of 0.928 despite differences in population, sensors, and acquisition protocols. The inference pipeline is available as an open-source, containerised API. These results demonstrate that consumer-grade smartphone imagery can support automated tooth-level anatomical mapping, offering a scalable, potentially low-cost foundation for remote screening and tele-dentistry in resource-constrained environments.

Text-Guided Refinement of Multi-sequence Glioma Subregion Segmentation with a Vision-Language Foundation Model

Background: Accurate glioma subregion delineation is important for radiotherapy planning and longitudinal monitoring, but manual contour correction is time-consuming. Models such as nnU-Net may generalize imperfectly and lack clinician-directed text correction. Purpose: We investigated adapting a three-dimensional (3D) vision-language foundation model for text-guided brain tumor segmentation refinement. Methods: We developed a lightweight VoxTell-based framework. Pretrained VoxTell generated initial masks. Oracle prompts derived from segmentation errors encoded target, action, location, imaging evidence, edit size, and preservation constraints. Frozen Qwen/VoxTell prompt embeddings were injected through trainable projections into its multiscale decoder conditioning; other weights remained frozen. Training, validation, and testing used 901, 100, and 250 BraTS-GLI cases. Cross-dataset transfer was evaluated on 100 meningioma, metastasis, pediatric tumor, and UPENN-GBM cases. Results: On the internal test set using post-contrast T1-weighted input, correct instructions improved subregion Dice similarity coefficient (DSC; enhancing tumor, edema, and necrotic/non-enhancing core) from $0.774\pm0.158$ to $0.796\pm0.137$. They outperformed blank prompts ($0.762\pm0.155$; Holm-adjusted $p<0.001$, $d_z=0.71$) and contradictory prompts ($0.770\pm0.163$; $p<0.001$, $d_z=0.48$). In cross-dataset testing, correct instructions improved DSC from $0.527\pm0.287$ to $0.550\pm0.278$ and outperformed contradictory instructions ($0.504\pm0.275$; $p<0.001$, $d_z=0.43$). Conclusion: A 3D vision-language foundation model can perform instruction-guided refinement of glioma subregion segmentations. Sensitivity to correct, blank, and contradictory prompts suggests text-dependent contour editing rather than nonspecific post-processing, supporting further evaluation as a clinician-in-the-loop tool.

Segmentation Pre-training for Label-Efficient Lumbar Spine Degeneration Grading

Automated assessment of degenerative pathology in the lumbar spine on magnetic resonance imaging (MRI) requires access to large-scale datasets of expert-annotated radiological gradings. In contrast, segmentation pseudo-labels can be generated by automated tools at negligible radiologist cost. We examine whether pre-training on segmentation can effectively replace a fraction of the manual grading annotations required for downstream supervision. We pre-train a 3D ResNet encoder to segment the vertebrae, intervertebral discs (IVDs), and the spinal canal, then fine-tune lightweight task-specific grading heads using different proportions of the available training data, ranging from $10\%$ to $100\%$. On a multicentre dataset of ${\sim}2{,}000$ subjects across 11 pathologies, segmentation pre-training, achieving a Dice score of $0.94$ against pseudo-labels, improved the task-averaged (macro) one-vs-rest ROC-AUC at all proportions. With only 20\% of grading labels after pre-training, the method achieved near full-supervision performance, with the largest gains observed for either low-prevalence or spatially grounded pathologies.

Beyond Isotropic Assumptions: Continuity-Constrained Segmentation and GPU Morphometry for Nanoscale GBM Analysis

Confocal microscopy of optically cleared and swelled tissue resolves complex biological structures in 3D, but such acquisitions are highly anisotropic: along the under-sampled axial direction the structure can appear discontinuous, hampering reconstruction and automated quantitative analysis. The usual remedy upsamples the axial dimension to an isotropic volume before training a segmentation model, which requires dense annotations in the upsampled space, a prohibitive labeling burden. We present an end-to-end, GPU-accelerated framework that overcomes this without additional annotations. The model is trained on the native acquisition volume; random rotation of training patches leverages the well-resolved lateral plane to supply the missing axial information, and a z-axis continuity loss keeps neighboring slices consistent. We adapt both a convolutional (3D U-Net) and a transformer (SwinUNETR) backbone, aggregate overlapping patches by Gaussian consensus, and compute point-spread-function-corrected membrane thickness by ray-surface intersection on the GPU. We apply the method to the glomerular basement membrane (GBM), a thin, highly convoluted part of the kidney's filtration barrier that grows more irregular in disease. Segmentation accuracy matches inter-expert agreement. Continuity-aware training improves reconstruction smoothness and suppresses a periodic terracing artifact at minimal accuracy cost. We quantify GBM thickness across the reconstructed 3D surface and capture disease-related thickening, enabling fully automated anisotropic 3D morphometry of biological structures without dense volumetric labels or image restoration.

Unsupervised Adversarial Domain Adaptation for Uterine layer Segmentation: From Labeled Cine to Unlabeled Dynamic EPI MRI

Uterine peristalsis is a key physiological phenomenon responsible for various functions across the menstrual cycle, intimately linked to uterine wall microstructure. Alterations in uterine motion and tissue properties are implicated in the etiology of gynecological diseases, yet these processes have been studied in isolation. We introduce a dynamic multi-echo gradient echo EPI framework for simultaneous characterization and correlation of uterine peristaltic activity and time-resolved T2* changes at 0.55T. Inherent susceptibility artifacts, reduced resolution, and burden of manual uterine layer annotation are addressed by an unsupervised adversarial domain adaptation framework, transferring segmentation knowledge from labeled cine MRI to unlabeled dynamic EPI. We implemented Unet-LSTM with multi-scale domain discriminators that exploits temporal layer dynamics. A Dice score of 0.88 and Jaccard index of 0.80 was achieved. Mean T2* values were 108ms, 76ms, and 124ms for the myometrium, junctional zone, and endometrium. A negative correlation between junctional zone area and T2* was observed in 14/39 cases, providing first insights into oxygenation patterns associated with junctional zone contraction and motion, demonstrating feasibility of assessing the interplay between contractility and dynamic T2* changes.

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.

A Unified 2D Framework for DeepLesion Detection, Segmentation and Short Report Generation

In previous work, we integrated large language models (LLMs) into the lesion segmentation model based on the ULS23 DeepLesion dataset, using short-form findings from the reports. In this study, we developed a unified 2D lesion analysis framework that integrates LLM-based reasoning, lesion bounding box detection, segmentation, and radiology report generation from the original DeepLesion dataset. In the testing phase, we achieved relatively high lesion bounding box detection accuracy with mAP50 of 70.1%, mAP50-95 of 46.4%; Lesion segmentation performance with a Dice score of 62.6%; short report generation accuracy with BLEU_1 score of 64.3%, BLEU_4 score of 49.6%, METEOR of 34.7%, and ROUGE_L of 60.1%. In this work, we address the challenging issue of segmentation in the original DeepLesion dataset and achieve a 28.5% Dice score improvement over the nnUNet lesion segmentation model. We also integrated spatial and anatomical context into the DeepLesion short report generation. We released the implementation, dataset, and models on Github. https://github.com/ruida/2D_DeepLesion_Foundation

NISF++: Geometrically-grounded implicit representations of 3D+time cardiac function from 2D short- and long-axis MR views

Clinical acquisition in cardiac magnetic resonance (CMR) imaging involves obtaining cross-sectional planes of the heart along the radial and longitudinal directions. Despite these planes being 2D cross-sectional images of the heart, radiologists understand the 3D spatial and continuous temporal nature of the organ being imaged. The same can not be said about the conventional deep learning architectures used to process CMR images, which rely on in-plane and grid-based operations, and are hence unable to organically integrate information from all imaging planes. This paper builds upon previous work on neural implicit segmentation functions (NISF) to overcome unaddressed challenges in cardiac function modeling in the CMR domain. For a given subject, our architecture builds a shared 3D+time representations from all available acquisition planes regardless of orientation. By design, predictions along any imaging plane orientation are cross-sections of the same 3D representation, leading to spatio-temporal consistency across all slices. Moreover, our architecture makes the rotation and translation parameters of imaging planes learnable, allowing us to correct for the commonplace respiratory and patient motion between slice acquisitions under a rigid assumption. Furthermore, interpolation of intensities and segmentation can be performed in 4D at any desired resolution. We perform our study on a 120 subject sub-cohort of CMR imaging data from the UK-Biobank. Our in-plane segmentation performance is on-par with existing CMR segmentation methods and explore how the majority of failure cases arise from limitations in the ground-truth segmentation, for which our representations make predictions with better anatomical accuracy than its original training data. We also evaluate our motion-correction capabilities, displaying quantitative and qualitative improvements in slice alignment.

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

Real-Time Visual Obstruction Detection in Surgical Augmented Reality

Surgical augmented reality (AR) can provide contextual guidance by overlaying virtual annotations, tool cues, and procedural information onto the surgical workspace. However, the virtual content may obstruct task-relevant real-world information, such as surgical instruments, and interfere with users' perception during time-sensitive surgical tasks. In this paper, we investigate visual obstruction detection for surgical AR and present a latency-aware pipeline that combines vision-language model (VLM)-based surgical-object recognition with segmentation-based obstruction reasoning. To reduce inference overhead, the system adopts a cascaded small-to-large VLM architecture with segmentation-guided early exiting and attention-based visual token pruning. The small VLM handles easy frames when its key-object prediction is supported by segmentation consistency, while difficult frames are forwarded to a large VLM with pruned visual tokens. We construct a pseudo-AR surgical obstruction detection benchmark by overlaying virtual content onto surgical-tool images and labeling whether the virtual content obstructs task-relevant instruments. Evaluation results show that the proposed system achieves 87.43% obstruction detection accuracy with an average end-to-end latency of 479 ms, reducing latency by 62.90% compared with a cloud large-model baseline. These results demonstrate the feasibility of latency-aware obstruction detection for surgical AR and motivate future work on dynamic surgical videos, multi-object scenes, and clinically grounded AR guidance content.

TAVI-TEC: An AI-Based Tool for Procedural Planning of Transcatheter Aortic Valve Implantation

Computed tomography angiography (CTA) is crucial for preprocedural TAVI planning, providing the anatomical information required for prosthesis sizing and vascular access assessment. As the volume of TAVI procedure increases, improving efficiency and standardizing annotations is becoming essential in clinical practice. This study presents TAVI-TEC, a fully automated artificial intelligence-based framework integrated into a web based DICOM viewer for routine preoperative TAVI planning. Pre-procedural CTA scans from patients undergoing TAVI with SAPIEN 3 Ultra (S3U) prostheses were processed using a fully automated pipeline. Deep learning-based segmentation of cardiovascular structures, calcification detection, centerline extraction, landmark identification, and annular plane definition was implemented to quantify key annular and aortic root measurements and color-coded maps of lumen reduction and vessel diameter for vascular access. A multilayer perceptron classifier was trained to predict prosthesis size prior to the TAVI procedure. Results revealed that TAVI-TEC enabled pre-procedural measurements in approximately 2-6 min. Strong agreement with clinician-derived measurements was observed for annular area (coefficient of concordance, CCC = 0.934; interclass correlation coefficient, ICC = 0.935; R^2 = 0.881) and perimeter (CCC = 0.909; ICC = 0.909; R^2 = 0.854). The valve-size prediction model achieved 82% overall accuracy, with most misclassifications occurring between adjacent prosthesis sizes. Though further multicenter validation and extension to additional measurements and valve platforms are required, the TAVI-TEC methodology may reduce operator variability in pre-TAVI measurements and streamline the preoperative workflows of the Heart Team for decision-making.

HERMES: A Hybrid Ensemble for Head-and-Neck Tumor Segmentation, TN Staging, and Recurrence-Free Survival on PET/CT

We present HERMES (Hybrid Ensemble for Radiotherapy-target segmentation, Malignancy staging, and Event-free Survival), a single containerized algorithm for the three HECKTOR 2026 subtasks: segmentation of the primary tumor (GTVp) and pathological lymph nodes (GTVn), radiological T/N staging, and recurrence-free survival (RFS), computed from a paired FDG-PET/CT scan and an electronic health record. A 10-fold ensemble of STU-Net Small networks produces the segmentation; the predicted mask then drives two downstream tasks. Rather than pass a generic radiomics vector to the staging models, we derive from the predicted masks a compact set of geometry features aligned with the size and number axes of AJCC/UICC 7th-edition radiological N/T staging. On internal cross-validation these features raise N-stage balanced accuracy from 0.691 to 0.720 (+0.030), our largest single design gain, at lower feature dimensionality. For prognosis we combine complementary deep and clinical risk experts in an equal-weight ensemble, and train one deep expert with a concordance-tracking survival loss of our own, whose value approximates the concordance index during training. Every component was selected on honest out-of-fold predictions under a regularization-oriented protocol, with no tuning on the public validation set, and deployed as two decorrelated submissions. On the HECKTOR 2026 validation leaderboard, HERMES achieved a weighted score of 0.6454 (Mean Dice 0.641, T balanced accuracy 0.580, N balanced accuracy 0.642, RFS C-index 0.679) and qualified for the testing phase. Team: AMC_HNC.