Pathologist Attention-Aligned Report Generation for Prostate Histopathology

The allocation of visual attention by pathologists during cancer diagnosis is a highly selective process that critically shapes the information extracted from whole-slide images (WSIs). Human attention helps medical imaging tasks such as classification and segmentation, and becomes a strong semantic cue for identifying diagnostically informative regions for report generation. In this paper, we introduce human attention into the training of pathologist report generation models. To this end, we collected a multimodal human-attention dataset of 121 prostate WSIs annotated with pathologists' multi-scale viewport trajectories synchronized with the pathologists' verbal descriptions and cursor movements for five clinically relevant components (e.g., Gleason patterns). Using this dataset, we finetune two report generation models with an attention-alignment loss that regularizes the model attention over image patches to match the distribution of pathologist attention. We evaluate our approach on prostate cancer report generation and visual question answering using two models with different internal attention mechanisms (i.e., how image tokens are integrated into the language decoder). Experiments show average gains of 10.9% on NLP-based metrics and 19.3% in accuracy across five clinically relevant report components. Further, model attention maps extracted at inference time, with minimal computational overhead, align more closely with pathologist attention, providing stronger visual support for the generated reports by highlighting the regions that most influence the output.

Divergent Gaze Patterns in Artistic Viewing: Spatial and Temporal Signatures of Attention Across Autistic Individuals, Artists, and Neurotypical Observers

How different populations visually explore artworks bears on cognitive science and on accessibility design, yet most eye-tracking work in autism has used social scenes rather than art, and has analysed where the eyes land while ignoring when and in what order. We present a comparative free-viewing study across three groups, autistic adults (ASD), trained artists, and neurotypical observers, who each viewed 30 paintings for 15s. We introduce a directed, metric-grounded framework that compares groups along two complementary axes: a spatial axis, in which one group's fixation-density map predicts another's fixations under six saliency metrics (AUC-Judd, NSS, CC, SIM, KL, Information Gain); and a temporal axis, in which individual scanpaths are compared with MultiMatch, ScanMatch, a foveal-disc IoU score (FDISS), and dynamic time warping (DTW). Fixations are extracted uniformly for all groups with a dispersion-threshold algorithm. Three results converge. (i)Artists and neurotypicals are almost indistinguishable in both space (density-map correlation CC=0.96) and time (they form the most alignable scanpath pair), whereas ASD gaze diverges from both. (ii)ASD attention is dissociated: it matches artists' wide spatial exploration (dispersion, explored area) but carries a distinct temporal signature, shorter fixations, less dwell, and the most idiosyncratic (least self-consistent) scanpaths of any group. (iii)ASD gaze is not selectively artist-like on any metric; if anything it is marginally closer to neurotypical. Together these findings indicate that autistic viewing of art is a distinct, group-specific attentional profile in both space and time, and they motivate population-conditioned models of aesthetic attention. We release all analysis code and per-stimulus results.

CheXthought: A global multimodal dataset of clinical chain-of-thought reasoning and visual attention for chest X-ray interpretation

Chest X-ray interpretation is one of the most frequently performed diagnostic tasks in medicine and a primary target for AI development, yet current vision--language models are primarily trained on datasets of paired images and reports, not the cognitive processes and visual attention that underlie clinical reasoning. Here, we present CheXthought, a global, multimodal resource containing 103,592 chain-of-thought reasoning traces and 6,609,082 synchronized visual attention annotations across 50,312 multi-read chest X-rays from 501 radiologists in 71 countries. Our analysis reveals clinical reasoning patterns in how experts deploy distinct visual search strategies, integrate clinical context, and communicate uncertainty. We demonstrate the clinical utility of CheXthought across four dimensions. First, CheXthought reasoning significantly outperforms state--of--the--art vision--language model chain-of-thought in factual accuracy and spatial grounding. Second, visual attention data used as an inference--time hint recovers missed findings and significantly reduces hallucinations. Third, models trained on CheXthought data achieve significantly stronger pathology classification, visual faithfulness, temporal reasoning and uncertainty communication. Fourth, leveraging CheXthought's multi-reader annotations, we predict both human--human and human--AI disagreement directly from an image, enabling transparent communication of case difficulty, uncertainty and model reliability. These findings establish CheXthought as a resource for advancing multimodal clinical reasoning and the development of more transparent, interpretable vision--language models.