Daily Papers

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback

Volumetry is one of the principal downstream applications of 3D medical image segmentation, for example, to detect abnormal tissue growth or for surgery planning. Conformal Prediction is a promising framework for uncertainty quantification, providing calibrated predictive intervals associated with automatic volume measurements. However, this methodology is based on the hypothesis that calibration and test samples are exchangeable, an assumption that is in practice often violated in medical image applications. A weighted formulation of Conformal Prediction can be framed to mitigate this issue, but its empirical investigation in the medical domain is still lacking. A potential reason is that it relies on the estimation of the density ratio between the calibration and test distributions, which is likely to be intractable in scenarios involving high-dimensional data. To circumvent this, we propose an efficient approach for density ratio estimation relying on the compressed latent representations generated by the segmentation model. Our experiments demonstrate the efficiency of our approach to reduce the coverage error in the presence of covariate shifts, in both synthetic and real-world settings. Our implementation is available at https://github.com/benolmbrt/wcp_miccai

This paper presents a novel framework for processing volumetric medical information using Visual Transformers (ViTs). First, We extend the state-of-the-art Swin Transformer model to the 3D medical domain. Second, we propose a new approach for processing volumetric information and encoding position in ViTs for 3D applications. We instantiate the proposed framework and present SuperFormer, a volumetric transformer-based approach for Magnetic Resonance Imaging (MRI) Super-Resolution. Our method leverages the 3D information of the MRI domain and uses a local self-attention mechanism with a 3D relative positional encoding to recover anatomical details. In addition, our approach takes advantage of multi-domain information from volume and feature domains and fuses them to reconstruct the High-Resolution MRI. We perform an extensive validation on the Human Connectome Project dataset and demonstrate the superiority of volumetric transformers over 3D CNN-based methods. Our code and pretrained models are available at https://github.com/BCV-Uniandes/SuperFormer.

Vision-language pre-training, i.e., aligning images with paired text, is a powerful paradigm to create encoders that can be directly used for tasks such as classification and retrieval, and for downstream tasks such as segmentation and report generation. In the 3D medical image domain, these capabilities allow vision-language encoders (VLEs) to support radiologists by retrieving patients with similar abnormalities or predicting likelihoods of abnormality. While the methodology holds promise, data availability limits the capabilities of current 3D VLEs. In this paper, we alleviate the lack of data by injecting additional inductive biases: introducing a report generation objective and pairing vision-language pre-training with vision-only pre-training. This allows us to leverage both image-only and paired image-text 3D datasets, increasing the total amount of data to which our model is exposed. Through these additional inductive biases, paired with best practices of the 3D medical imaging domain, we develop the Comprehensive Language-image Pre-training (COLIPRI) encoder family. Our COLIPRI encoders achieve state-of-the-art performance in report generation, classification probing, and zero-shot classification, and remain competitive for semantic segmentation.

In this work, we present MedImageInsight, an open-source medical imaging embedding model. MedImageInsight is trained on medical images with associated text and labels across a diverse collection of domains, including X-Ray, CT, MRI, dermoscopy, OCT, fundus photography, ultrasound, histopathology, and mammography. Rigorous evaluations demonstrate MedImageInsight's ability to achieve state-of-the-art (SOTA) or human expert level performance across classification, image-image search, and fine-tuning tasks. Specifically, on public datasets, MedImageInsight achieves SOTA in CT 3D medical image retrieval, as well as SOTA in disease classification and search for chest X-ray, dermatology, and OCT imaging. Furthermore, MedImageInsight achieves human expert performance in bone age estimation (on both public and partner data), as well as AUC above 0.9 in most other domains. When paired with a text decoder, MedImageInsight achieves near SOTA level single image report findings generation with less than 10\% the parameters of other models. Compared to fine-tuning GPT-4o with only MIMIC-CXR data for the same task, MedImageInsight outperforms in clinical metrics, but underperforms on lexical metrics where GPT-4o sets a new SOTA. Importantly for regulatory purposes, MedImageInsight can generate ROC curves, adjust sensitivity and specificity based on clinical need, and provide evidence-based decision support through image-image search (which can also enable retrieval augmented generation). In an independent clinical evaluation of image-image search in chest X-ray, MedImageInsight outperformed every other publicly available foundation model evaluated by large margins (over 6 points AUC), and significantly outperformed other models in terms of AI fairness (across age and gender). We hope releasing MedImageInsight will help enhance collective progress in medical imaging AI research and development.

Foundation models for interactive segmentation in 2D natural images and videos have sparked significant interest in building 3D foundation models for medical imaging. However, the domain gaps and clinical use cases for 3D medical imaging require a dedicated model that diverges from existing 2D solutions. Specifically, such foundation models should support a full workflow that can actually reduce human effort. Treating 3D medical images as sequences of 2D slices and reusing interactive 2D foundation models seems straightforward, but 2D annotation is too time-consuming for 3D tasks. Moreover, for large cohort analysis, it's the highly accurate automatic segmentation models that reduce the most human effort. However, these models lack support for interactive corrections and lack zero-shot ability for novel structures, which is a key feature of "foundation". While reusing pre-trained 2D backbones in 3D enhances zero-shot potential, their performance on complex 3D structures still lags behind leading 3D models. To address these issues, we present VISTA3D, Versatile Imaging SegmenTation and Annotation model, that targets to solve all these challenges and requirements with one unified foundation model. VISTA3D is built on top of the well-established 3D segmentation pipeline, and it is the first model to achieve state-of-the-art performance in both 3D automatic (supporting 127 classes) and 3D interactive segmentation, even when compared with top 3D expert models on large and diverse benchmarks. Additionally, VISTA3D's 3D interactive design allows efficient human correction, and a novel 3D supervoxel method that distills 2D pretrained backbones grants VISTA3D top 3D zero-shot performance. We believe the model, recipe, and insights represent a promising step towards a clinically useful 3D foundation model. Code and weights are publicly available at https://github.com/Project-MONAI/VISTA.

The performance on deep learning is significantly affected by volume of training data. Models pre-trained from massive dataset such as ImageNet become a powerful weapon for speeding up training convergence and improving accuracy. Similarly, models based on large dataset are important for the development of deep learning in 3D medical images. However, it is extremely challenging to build a sufficiently large dataset due to difficulty of data acquisition and annotation in 3D medical imaging. We aggregate the dataset from several medical challenges to build 3DSeg-8 dataset with diverse modalities, target organs, and pathologies. To extract general medical three-dimension (3D) features, we design a heterogeneous 3D network called Med3D to co-train multi-domain 3DSeg-8 so as to make a series of pre-trained models. We transfer Med3D pre-trained models to lung segmentation in LIDC dataset, pulmonary nodule classification in LIDC dataset and liver segmentation on LiTS challenge. Experiments show that the Med3D can accelerate the training convergence speed of target 3D medical tasks 2 times compared with model pre-trained on Kinetics dataset, and 10 times compared with training from scratch as well as improve accuracy ranging from 3% to 20%. Transferring our Med3D model on state-the-of-art DenseASPP segmentation network, in case of single model, we achieve 94.6\% Dice coefficient which approaches the result of top-ranged algorithms on the LiTS challenge.

Convolutional Neural Networks (CNNs) and Vision Transformers (ViT) have been pivotal in biomedical image segmentation, yet their ability to manage long-range dependencies remains constrained by inherent locality and computational overhead. To overcome these challenges, in this technical report, we first propose xLSTM-UNet, a UNet structured deep learning neural network that leverages Vision-LSTM (xLSTM) as its backbone for medical image segmentation. xLSTM is a recently proposed as the successor of Long Short-Term Memory (LSTM) networks and have demonstrated superior performance compared to Transformers and State Space Models (SSMs) like Mamba in Neural Language Processing (NLP) and image classification (as demonstrated in Vision-LSTM, or ViL implementation). Here, xLSTM-UNet we designed extend the success in biomedical image segmentation domain. By integrating the local feature extraction strengths of convolutional layers with the long-range dependency capturing abilities of xLSTM, xLSTM-UNet offers a robust solution for comprehensive image analysis. We validate the efficacy of xLSTM-UNet through experiments. Our findings demonstrate that xLSTM-UNet consistently surpasses the performance of leading CNN-based, Transformer-based, and Mamba-based segmentation networks in multiple datasets in biomedical segmentation including organs in abdomen MRI, instruments in endoscopic images, and cells in microscopic images. With comprehensive experiments performed, this technical report highlights the potential of xLSTM-based architectures in advancing biomedical image analysis in both 2D and 3D. The code, models, and datasets are publicly available at http://tianrun-chen.github.io/xLSTM-UNet/{http://tianrun-chen.github.io/xLSTM-Unet/}

In medical imaging, the primary challenge is collecting large-scale labeled data due to privacy concerns, logistics, and high labeling costs. In this work, we present the UK Biobank Organs and Bones (UKBOB), the largest labeled dataset of body organs, comprising 51,761 MRI 3D samples (equivalent to 17.9 million 2D images) and more than 1.37 billion 2D segmentation masks of 72 organs, all based on the UK Biobank MRI dataset. We utilize automatic labeling, introduce an automated label cleaning pipeline with organ-specific filters, and manually annotate a subset of 300 MRIs with 11 abdominal classes to validate the quality (referred to as UKBOB-manual). This approach allows for scaling up the dataset collection while maintaining confidence in the labels. We further confirm the validity of the labels by demonstrating zero-shot generalization of trained models on the filtered UKBOB to other small labeled datasets from similar domains (e.g., abdominal MRI). To further mitigate the effect of noisy labels, we propose a novel method called Entropy Test-time Adaptation (ETTA) to refine the segmentation output. We use UKBOB to train a foundation model, Swin-BOB, for 3D medical image segmentation based on the Swin-UNetr architecture, achieving state-of-the-art results in several benchmarks in 3D medical imaging, including the BRATS brain MRI tumor challenge (with a 0.4% improvement) and the BTCV abdominal CT scan benchmark (with a 1.3% improvement). The pre-trained models and the code are available at https://emmanuelleb985.github.io/ukbob , and the filtered labels will be made available with the UK Biobank.

Vision-Language Models (VLMs) have shown promise in various 2D visual tasks, yet their readiness for 3D clinical diagnosis remains unclear due to stringent demands for recognition precision, reasoning ability, and domain knowledge. To systematically evaluate these dimensions, we present DeepTumorVQA, a diagnostic visual question answering (VQA) benchmark targeting abdominal tumors in CT scans. It comprises 9,262 CT volumes (3.7M slices) from 17 public datasets, with 395K expert-level questions spanning four categories: Recognition, Measurement, Visual Reasoning, and Medical Reasoning. DeepTumorVQA introduces unique challenges, including small tumor detection and clinical reasoning across 3D anatomy. Benchmarking four advanced VLMs (RadFM, M3D, Merlin, CT-CHAT), we find current models perform adequately on measurement tasks but struggle with lesion recognition and reasoning, and are still not meeting clinical needs. Two key insights emerge: (1) large-scale multimodal pretraining plays a crucial role in DeepTumorVQA testing performance, making RadFM stand out among all VLMs. (2) Our dataset exposes critical differences in VLM components, where proper image preprocessing and design of vision modules significantly affect 3D perception. To facilitate medical multimodal research, we have released DeepTumorVQA as a rigorous benchmark: https://github.com/Schuture/DeepTumorVQA.

Transforming two-dimensional (2D) images into three-dimensional (3D) volumes is a well-known yet challenging problem for the computer vision community. In the medical domain, a few previous studies attempted to convert two or more input radiographs into computed tomography (CT) volumes. Following their effort, we introduce a diffusion model-based technology that can rotate the anatomical content of any input radiograph in 3D space, potentially enabling the visualization of the entire anatomical content of the radiograph from any viewpoint in 3D. Similar to previous studies, we used CT volumes to create Digitally Reconstructed Radiographs (DRRs) as the training data for our model. However, we addressed two significant limitations encountered in previous studies: 1. We utilized conditional diffusion models with classifier-free guidance instead of Generative Adversarial Networks (GANs) to achieve higher mode coverage and improved output image quality, with the only trade-off being slower inference time, which is often less critical in medical applications; and 2. We demonstrated that the unreliable output of style transfer deep learning (DL) models, such as Cycle-GAN, to transfer the style of actual radiographs to DRRs could be replaced with a simple yet effective training transformation that randomly changes the pixel intensity histograms of the input and ground-truth imaging data during training. This transformation makes the diffusion model agnostic to any distribution variations of the input data pixel intensity, enabling the reliable training of a DL model on input DRRs and applying the exact same model to conventional radiographs (or DRRs) during inference.

Existing foundation models (FMs) in the medical domain often require extensive fine-tuning or rely on training resource-intensive decoders, while many existing encoders are pretrained with objectives biased toward specific tasks. This illustrates a need for a strong, task-agnostic foundation model that requires minimal fine-tuning beyond feature extraction. In this work, we introduce a suite of task-agnostic pretraining of CT foundation models (TAP-CT): a simple yet effective adaptation of Vision Transformers (ViTs) and DINOv2 for volumetric data, enabling scalable self-supervised pretraining directly on 3D CT volumes. Our approach incorporates targeted modifications to patch embeddings, positional encodings, and volumetric augmentations, making the architecture depth-aware while preserving the simplicity of the underlying architectures. We show that large-scale 3D pretraining on an extensive in-house CT dataset (105K volumes) yields stable, robust frozen representations that generalize strongly across downstream tasks. To promote transparency and reproducibility, and to establish a powerful, low-resource baseline for future research in medical imaging, we will release all pretrained models, experimental configurations, and downstream benchmark code at https://huggingface.co/fomofo/tap-ct-b-3d.

Foundation models have demonstrated remarkable potential in medical domain. However, their application to complex cardiovascular diagnostics remains underexplored. In this paper, we present Cardiac-CLIP, a multi-modal foundation model designed for 3D cardiac CT images. Cardiac-CLIP is developed through a two-stage pre-training strategy. The first stage employs a 3D masked autoencoder (MAE) to perform self-supervised representation learning from large-scale unlabeled volumetric data, enabling the visual encoder to capture rich anatomical and contextual features. In the second stage, contrastive learning is introduced to align visual and textual representations, facilitating cross-modal understanding. To support the pre-training, we collect 16641 real clinical CT scans, supplemented by 114k publicly available data. Meanwhile, we standardize free-text radiology reports into unified templates and construct the pathology vectors according to diagnostic attributes, based on which the soft-label matrix is generated to supervise the contrastive learning process. On the other hand, to comprehensively evaluate the effectiveness of Cardiac-CLIP, we collect 6,722 real-clinical data from 12 independent institutions, along with the open-source data to construct the evaluation dataset. Specifically, Cardiac-CLIP is comprehensively evaluated across multiple tasks, including cardiovascular abnormality classification, information retrieval and clinical analysis. Experimental results demonstrate that Cardiac-CLIP achieves state-of-the-art performance across various downstream tasks in both internal and external data. Particularly, Cardiac-CLIP exhibits great effectiveness in supporting complex clinical tasks such as the prospective prediction of acute coronary syndrome, which is notoriously difficult in real-world scenarios.

While making a tremendous impact in various fields, deep neural networks usually require large amounts of labeled data for training which are expensive to collect in many applications, especially in the medical domain. Unlabeled data, on the other hand, is much more abundant. Semi-supervised learning techniques, such as co-training, could provide a powerful tool to leverage unlabeled data. In this paper, we propose a novel framework, uncertainty-aware multi-view co-training (UMCT), to address semi-supervised learning on 3D data, such as volumetric data from medical imaging. In our work, co-training is achieved by exploiting multi-viewpoint consistency of 3D data. We generate different views by rotating or permuting the 3D data and utilize asymmetrical 3D kernels to encourage diversified features in different sub-networks. In addition, we propose an uncertainty-weighted label fusion mechanism to estimate the reliability of each view's prediction with Bayesian deep learning. As one view requires the supervision from other views in co-training, our self-adaptive approach computes a confidence score for the prediction of each unlabeled sample in order to assign a reliable pseudo label. Thus, our approach can take advantage of unlabeled data during training. We show the effectiveness of our proposed semi-supervised method on several public datasets from medical image segmentation tasks (NIH pancreas & LiTS liver tumor dataset). Meanwhile, a fully-supervised method based on our approach achieved state-of-the-art performances on both the LiTS liver tumor segmentation and the Medical Segmentation Decathlon (MSD) challenge, demonstrating the robustness and value of our framework, even when fully supervised training is feasible.

Accurate and efficient 3D segmentation is essential for both clinical and research applications. While foundation models like SAM have revolutionized interactive segmentation, their 2D design and domain shift limitations make them ill-suited for 3D medical images. Current adaptations address some of these challenges but remain limited, either lacking volumetric awareness, offering restricted interactivity, or supporting only a small set of structures and modalities. Usability also remains a challenge, as current tools are rarely integrated into established imaging platforms and often rely on cumbersome web-based interfaces with restricted functionality. We introduce nnInteractive, the first comprehensive 3D interactive open-set segmentation method. It supports diverse prompts-including points, scribbles, boxes, and a novel lasso prompt-while leveraging intuitive 2D interactions to generate full 3D segmentations. Trained on 120+ diverse volumetric 3D datasets (CT, MRI, PET, 3D Microscopy, etc.), nnInteractive sets a new state-of-the-art in accuracy, adaptability, and usability. Crucially, it is the first method integrated into widely used image viewers (e.g., Napari, MITK), ensuring broad accessibility for real-world clinical and research applications. Extensive benchmarking demonstrates that nnInteractive far surpasses existing methods, setting a new standard for AI-driven interactive 3D segmentation. nnInteractive is publicly available: https://github.com/MIC-DKFZ/napari-nninteractive (Napari plugin), https://www.mitk.org/MITK-nnInteractive (MITK integration), https://github.com/MIC-DKFZ/nnInteractive (Python backend).

Accurate 3D scene reconstruction is essential for numerous medical tasks. Given the challenges in obtaining ground truth data, there has been an increasing focus on self-supervised learning (SSL) for endoscopic depth estimation as a basis for scene reconstruction. While foundation models have shown remarkable progress in visual tasks, their direct application to the medical domain often leads to suboptimal results. However, the visual features from these models can still enhance endoscopic tasks, emphasizing the need for efficient adaptation strategies, which still lack exploration currently. In this paper, we introduce Endo3DAC, a unified framework for endoscopic scene reconstruction that efficiently adapts foundation models. We design an integrated network capable of simultaneously estimating depth maps, relative poses, and camera intrinsic parameters. By freezing the backbone foundation model and training only the specially designed Gated Dynamic Vector-Based Low-Rank Adaptation (GDV-LoRA) with separate decoder heads, Endo3DAC achieves superior depth and pose estimation while maintaining training efficiency. Additionally, we propose a 3D scene reconstruction pipeline that optimizes depth maps' scales, shifts, and a few parameters based on our integrated network. Extensive experiments across four endoscopic datasets demonstrate that Endo3DAC significantly outperforms other state-of-the-art methods while requiring fewer trainable parameters. To our knowledge, we are the first to utilize a single network that only requires surgical videos to perform both SSL depth estimation and scene reconstruction tasks. The code will be released upon acceptance.

Recently, the Segment Anything Model (SAM) has demonstrated promising segmentation capabilities in a variety of downstream segmentation tasks. However in the context of universal medical image segmentation there exists a notable performance discrepancy when directly applying SAM due to the domain gap between natural and 2D/3D medical data. In this work, we propose a dual-branch adapted SAM framework, named DB-SAM, that strives to effectively bridge this domain gap. Our dual-branch adapted SAM contains two branches in parallel: a ViT branch and a convolution branch. The ViT branch incorporates a learnable channel attention block after each frozen attention block, which captures domain-specific local features. On the other hand, the convolution branch employs a light-weight convolutional block to extract domain-specific shallow features from the input medical image. To perform cross-branch feature fusion, we design a bilateral cross-attention block and a ViT convolution fusion block, which dynamically combine diverse information of two branches for mask decoder. Extensive experiments on large-scale medical image dataset with various 3D and 2D medical segmentation tasks reveal the merits of our proposed contributions. On 21 3D medical image segmentation tasks, our proposed DB-SAM achieves an absolute gain of 8.8%, compared to a recent medical SAM adapter in the literature. The code and model are available at https://github.com/AlfredQin/DB-SAM.

We present SAM4EM, a novel approach for 3D segmentation of complex neural structures in electron microscopy (EM) data by leveraging the Segment Anything Model (SAM) alongside advanced fine-tuning strategies. Our contributions include the development of a prompt-free adapter for SAM using two stage mask decoding to automatically generate prompt embeddings, a dual-stage fine-tuning method based on Low-Rank Adaptation (LoRA) for enhancing segmentation with limited annotated data, and a 3D memory attention mechanism to ensure segmentation consistency across 3D stacks. We further release a unique benchmark dataset for the segmentation of astrocytic processes and synapses. We evaluated our method on challenging neuroscience segmentation benchmarks, specifically targeting mitochondria, glia, and synapses, with significant accuracy improvements over state-of-the-art (SOTA) methods, including recent SAM-based adapters developed for the medical domain and other vision transformer-based approaches. Experimental results indicate that our approach outperforms existing solutions in the segmentation of complex processes like glia and post-synaptic densities. Our code and models are available at https://github.com/Uzshah/SAM4EM.

The lack of labeled datasets in 3D vision for surgical scenes inhibits the development of robust 3D reconstruction algorithms in the medical domain. Despite the popularity of Neural Radiance Fields and 3D Gaussian Splatting in the general computer vision community, these systems have yet to find consistent success in surgical scenes due to challenges such as non-stationary lighting and non-Lambertian surfaces. As a result, the need for labeled surgical datasets continues to grow. In this work, we introduce a differentiable rendering framework for material and lighting estimation from endoscopic images and known geometry. Compared to previous approaches that model lighting and material jointly as radiance, we explicitly disentangle these scene properties for robust and photorealistic novel view synthesis. To disambiguate the training process, we formulate domain-specific properties inherent in surgical scenes. Specifically, we model the scene lighting as a simple spotlight and material properties as a bidirectional reflectance distribution function, parameterized by a neural network. By grounding color predictions in the rendering equation, we can generate photorealistic images at arbitrary camera poses. We evaluate our method with various sequences from the Colonoscopy 3D Video Dataset and show that our method produces competitive novel view synthesis results compared with other approaches. Furthermore, we demonstrate that synthetic data can be used to develop 3D vision algorithms by finetuning a depth estimation model with our rendered outputs. Overall, we see that the depth estimation performance is on par with fine-tuning with the original real images.

Autoregressive modeling has been a huge success in the field of natural language processing (NLP). Recently, autoregressive models have emerged as a significant area of focus in computer vision, where they excel in producing high-quality visual content. Autoregressive models in NLP typically operate on subword tokens. However, the representation strategy in computer vision can vary in different levels, i.e., pixel-level, token-level, or scale-level, reflecting the diverse and hierarchical nature of visual data compared to the sequential structure of language. This survey comprehensively examines the literature on autoregressive models applied to vision. To improve readability for researchers from diverse research backgrounds, we start with preliminary sequence representation and modeling in vision. Next, we divide the fundamental frameworks of visual autoregressive models into three general sub-categories, including pixel-based, token-based, and scale-based models based on the strategy of representation. We then explore the interconnections between autoregressive models and other generative models. Furthermore, we present a multi-faceted categorization of autoregressive models in computer vision, including image generation, video generation, 3D generation, and multi-modal generation. We also elaborate on their applications in diverse domains, including emerging domains such as embodied AI and 3D medical AI, with about 250 related references. Finally, we highlight the current challenges to autoregressive models in vision with suggestions about potential research directions. We have also set up a Github repository to organize the papers included in this survey at: https://github.com/ChaofanTao/Autoregressive-Models-in-Vision-Survey.

Multimodal Large Language Models (MLLMs) have demonstrated remarkable effectiveness in various general-domain scenarios, such as visual question answering and image captioning. Recently, researchers have increasingly focused on empowering MLLMs with medical conversational abilities, which hold significant promise for clinical applications. However, medical data presents unique challenges due to its heterogeneous nature -- encompassing diverse modalities including 2D images, 3D volumetric scans, and temporal video sequences. The substantial domain gap and data format inconsistencies across these modalities have hindered the development of unified medical MLLMs. To address these challenges, we propose Fleming-VL, a unified end-to-end framework for comprehensive medical visual understanding across heterogeneous modalities. Fleming-VL tackles this problem from a data-centric perspective through three key strategies: (1) scaling up pretraining by integrating long-context data from both natural and medical-specific domains; (2) complementing fine-tuning with rare medical data, including holistic video analysis and underrepresented 2D modalities such as ultrasound and dermoscopy images; (3) extending existing evaluation frameworks to incorporate 3D volumetric and video understanding benchmarks. Through supervised fine-tuning (SFT) and group relative policy optimization (GRPO), we develop Fleming-VL in multiple model scales. Extensive experiments demonstrate that Fleming-VL achieves state-of-the-art performance across multiple benchmarks, including medical VQA, video QA, and 3D medical image understanding. We publicly release Fleming-VL to promote transparent, reproducible, and auditable progress in medical AI.

Placenta volume measurement from 3D ultrasound images is critical for predicting pregnancy outcomes, and manual annotation is the gold standard. However, such manual annotation is expensive and time-consuming. Automated segmentation algorithms can often successfully segment the placenta, but these methods may not consistently produce robust segmentations suitable for practical use. Recently, inspired by the Segment Anything Model (SAM), deep learning-based interactive segmentation models have been widely applied in the medical imaging domain. These models produce a segmentation from visual prompts provided to indicate the target region, which may offer a feasible solution for practical use. However, none of these models are specifically designed for interactively segmenting 3D ultrasound images, which remain challenging due to the inherent noise of this modality. In this paper, we evaluate publicly available state-of-the-art 3D interactive segmentation models in contrast to a human-in-the-loop approach for the placenta segmentation task. The Dice score, normalized surface Dice, averaged symmetric surface distance, and 95-percent Hausdorff distance are used as evaluation metrics. We consider a Dice score of 0.95 a successful segmentation. Our results indicate that the human-in-the-loop segmentation model reaches this standard. Moreover, we assess the efficiency of the human-in-the-loop model as a function of the amount of prompts. Our results demonstrate that the human-in-the-loop model is both effective and efficient for interactive placenta segmentation. The code is available at https://github.com/MedICL-VU/PRISM-placenta.

Despite that the segment anything model (SAM) achieved impressive results on general-purpose semantic segmentation with strong generalization ability on daily images, its demonstrated performance on medical image segmentation is less precise and not stable, especially when dealing with tumor segmentation tasks that involve objects of small sizes, irregular shapes, and low contrast. Notably, the original SAM architecture is designed for 2D natural images, therefore would not be able to extract the 3D spatial information from volumetric medical data effectively. In this paper, we propose a novel adaptation method for transferring SAM from 2D to 3D for promptable medical image segmentation. Through a holistically designed scheme for architecture modification, we transfer the SAM to support volumetric inputs while retaining the majority of its pre-trained parameters for reuse. The fine-tuning process is conducted in a parameter-efficient manner, wherein most of the pre-trained parameters remain frozen, and only a few lightweight spatial adapters are introduced and tuned. Regardless of the domain gap between natural and medical data and the disparity in the spatial arrangement between 2D and 3D, the transformer trained on natural images can effectively capture the spatial patterns present in volumetric medical images with only lightweight adaptations. We conduct experiments on four open-source tumor segmentation datasets, and with a single click prompt, our model can outperform domain state-of-the-art medical image segmentation models on 3 out of 4 tasks, specifically by 8.25%, 29.87%, and 10.11% for kidney tumor, pancreas tumor, colon cancer segmentation, and achieve similar performance for liver tumor segmentation. We also compare our adaptation method with existing popular adapters, and observed significant performance improvement on most datasets.

Coronary microvascular disease constitutes a substantial risk to human health. Employing computer-aided analysis and diagnostic systems, medical professionals can intervene early in disease progression, with 3D vessel segmentation serving as a crucial component. Nevertheless, conventional U-Net architectures tend to yield incoherent and imprecise segmentation outcomes, particularly for small vessel structures. While models with attention mechanisms, such as Transformers and large convolutional kernels, demonstrate superior performance, their extensive computational demands during training and inference lead to increased time complexity. In this study, we leverage Fourier domain learning as a substitute for multi-scale convolutional kernels in 3D hierarchical segmentation models, which can reduce computational expenses while preserving global receptive fields within the network. Furthermore, a zero-parameter frequency domain fusion method is designed to improve the skip connections in U-Net architecture. Experimental results on a public dataset and an in-house dataset indicate that our novel Fourier transformation-based network achieves remarkable dice performance (84.37\% on ASACA500 and 80.32\% on ImageCAS) in tubular vessel segmentation tasks and substantially reduces computational requirements without compromising global receptive fields.

Tooth segmentation is a pivotal step in modern digital dentistry, essential for applications across orthodontic diagnosis and treatment planning. Despite its importance, this process is fraught with challenges due to the high noise and low contrast inherent in 2D and 3D tooth data. Both Convolutional Neural Networks (CNNs) and Transformers has shown promise in medical image segmentation, yet each method has limitations in handling long-range dependencies and computational complexity. To address this issue, this paper introduces T-Mamba, integrating frequency-based features and shared bi-positional encoding into vision mamba to address limitations in efficient global feature modeling. Besides, we design a gate selection unit to integrate two features in spatial domain and one feature in frequency domain adaptively. T-Mamba is the first work to introduce frequency-based features into vision mamba, and its flexibility allows it to process both 2D and 3D tooth data without the need for separate modules. Also, the TED3, a large-scale public tooth 2D dental X-ray dataset, has been presented in this paper. Extensive experiments demonstrate that T-Mamba achieves new SOTA results on a public tooth CBCT dataset and outperforms previous SOTA methods on TED3 dataset. The code and models are publicly available at: https://github.com/isbrycee/T-Mamba.

Domain Adaptation (DA) is important for deep learning-based medical image segmentation models to deal with testing images from a new target domain. As the source-domain data are usually unavailable when a trained model is deployed at a new center, Source-Free Domain Adaptation (SFDA) is appealing for data and annotation-efficient adaptation to the target domain. However, existing SFDA methods have a limited performance due to lack of sufficient supervision with source-domain images unavailable and target-domain images unlabeled. We propose a novel Uncertainty-aware Pseudo Label guided (UPL) SFDA method for medical image segmentation. Specifically, we propose Target Domain Growing (TDG) to enhance the diversity of predictions in the target domain by duplicating the pre-trained model's prediction head multiple times with perturbations. The different predictions in these duplicated heads are used to obtain pseudo labels for unlabeled target-domain images and their uncertainty to identify reliable pseudo labels. We also propose a Twice Forward pass Supervision (TFS) strategy that uses reliable pseudo labels obtained in one forward pass to supervise predictions in the next forward pass. The adaptation is further regularized by a mean prediction-based entropy minimization term that encourages confident and consistent results in different prediction heads. UPL-SFDA was validated with a multi-site heart MRI segmentation dataset, a cross-modality fetal brain segmentation dataset, and a 3D fetal tissue segmentation dataset. It improved the average Dice by 5.54, 5.01 and 6.89 percentage points for the three tasks compared with the baseline, respectively, and outperformed several state-of-the-art SFDA methods.

Medical image segmentation faces critical challenges in semi-supervised learning scenarios due to severe annotation scarcity requiring expert radiological knowledge, significant inter-annotator variability across different viewpoints and expertise levels, and inadequate multi-scale feature integration for precise boundary delineation in complex anatomical structures. Existing semi-supervised methods demonstrate substantial performance degradation compared to fully supervised approaches, particularly in small target segmentation and boundary refinement tasks. To address these fundamental challenges, we propose SASNet (Scale-aware Adaptive Supervised Network), a dual-branch architecture that leverages both low-level and high-level feature representations through novel scale-aware adaptive reweight mechanisms. Our approach introduces three key methodological innovations, including the Scale-aware Adaptive Reweight strategy that dynamically weights pixel-wise predictions using temporal confidence accumulation, the View Variance Enhancement mechanism employing 3D Fourier domain transformations to simulate annotation variability, and segmentation-regression consistency learning through signed distance map algorithms for enhanced boundary precision. These innovations collectively address the core limitations of existing semi-supervised approaches by integrating spatial, temporal, and geometric consistency principles within a unified optimization framework. Comprehensive evaluation across LA, Pancreas-CT, and BraTS datasets demonstrates that SASNet achieves superior performance with limited labeled data, surpassing state-of-the-art semi-supervised methods while approaching fully supervised performance levels. The source code for SASNet is available at https://github.com/HUANGLIZI/SASNet.

In biomedical imaging analysis, the dichotomy between 2D and 3D data presents a significant challenge. While 3D volumes offer superior real-world applicability, they are less available for each modality and not easy to train in large scale, whereas 2D samples are abundant but less comprehensive. This paper introduces the Cross-D Conv operation, a novel approach that bridges the dimensional gap by learning the phase shifting in the Fourier domain. Our method enables seamless weight transfer between 2D and 3D convolution operations, effectively facilitating cross-dimensional learning. The proposed architecture leverages the abundance of 2D training data to enhance 3D model performance, offering a practical solution to the multimodal data scarcity challenge in 3D medical model pretraining. Experimental validation on the RadImagenet (2D) and multimodal (3D) sets demonstrates that our approach achieves comparable or superior performance in feature quality assessment comparable to conventional methods. The enhanced convolution operation presents new opportunities for developing efficient classification and segmentation models in medical imaging. This work represents an advancement in cross-dimensional and multi-modal medical image analysis, offering a robust framework for utilizing 2D priors in 3D model pretraining or vice versa while maintaining computational efficiency.

Detecting and delineating tiny targets in 3D brain scans is a central yet under-addressed challenge in medical imaging.In ischemic stroke, for instance, the culprit thrombus is small, low-contrast, and variably expressed across modalities(e.g., susceptibility-weighted T2 blooming, diffusion restriction on DWI/ADC), while real-world multi-center dataintroduce domain shifts, anisotropy, and frequent missing sequences. We introduce a methodology that couples an attention-based recurrent segmentation network (UpAttLLSTM), a training schedule that progressively increases the difficulty of hetero-modal learning, with gradual modality dropout, UpAttLLSTM aggregates context across slices via recurrent units (2.5D) and uses attention gates to fuse complementary cues across available sequences, making it robust to anisotropy and class imbalance. Gradual modality dropout systematically simulates site heterogeneity,noise, and missing modalities during training, acting as both augmentation and regularization to improve multi-center generalization. On a monocentric cohort, our approach detects thrombi in >90% of cases with a Dice score of 0.65. In a multi-center setting with missing modalities, it achieves-80% detection with a Dice score around 0.35. Beyond stroke, the proposed methodology directly transfers to other small-lesion tasks in 3D medical imaging where targets are scarce, subtle, and modality-dependent

Expanding multimodal representations to novel modalities is constrained by reliance on large-scale paired datasets (e.g., text-image, text-audio, text-3D, text-molecule), which are costly and often infeasible in domains requiring expert annotation such as medical imaging and molecular analysis. We introduce TextME, the first text-only modality expansion framework, to the best of our knowledge, projecting diverse modalities into LLM embedding space as a unified anchor. Our approach exploits the geometric structure of pretrained contrastive encoders to enable zero-shot cross-modal transfer using only text descriptions, without paired supervision. We empirically validate that such consistent modality gaps exist across image, video, audio, 3D, X-ray, and molecular domains, demonstrating that text-only training can preserve substantial performance of pretrained encoders. We further show that our framework enables emergent cross-modal retrieval between modality pairs not explicitly aligned during training (e.g., audio-to-image, 3D-to-image). These results establish text-only training as a practical alternative to paired supervision for modality expansion.

Transformers have achieved remarkable success across multiple fields, yet their impact on 3D medical image segmentation remains limited with convolutional networks still dominating major benchmarks. In this work, we a) analyze current Transformer-based segmentation models and identify critical shortcomings, particularly their over-reliance on convolutional blocks. Further, we demonstrate that in some architectures, performance is unaffected by the absence of the Transformer, thereby demonstrating their limited effectiveness. To address these challenges, we move away from hybrid architectures and b) introduce a fully Transformer-based segmentation architecture, termed Primus. Primus leverages high-resolution tokens, combined with advances in positional embeddings and block design, to maximally leverage its Transformer blocks. Through these adaptations Primus surpasses current Transformer-based methods and competes with state-of-the-art convolutional models on multiple public datasets. By doing so, we create the first pure Transformer architecture and take a significant step towards making Transformers state-of-the-art for 3D medical image segmentation.

Computer-aided medical image segmentation has been applied widely in diagnosis and treatment to obtain clinically useful information of shapes and volumes of target organs and tissues. In the past several years, convolutional neural network (CNN) based methods (e.g., U-Net) have dominated this area, but still suffered from inadequate long-range information capturing. Hence, recent work presented computer vision Transformer variants for medical image segmentation tasks and obtained promising performances. Such Transformers model long-range dependency by computing pair-wise patch relations. However, they incur prohibitive computational costs, especially on 3D medical images (e.g., CT and MRI). In this paper, we propose a new method called Dilated Transformer, which conducts self-attention for pair-wise patch relations captured alternately in local and global scopes. Inspired by dilated convolution kernels, we conduct the global self-attention in a dilated manner, enlarging receptive fields without increasing the patches involved and thus reducing computational costs. Based on this design of Dilated Transformer, we construct a U-shaped encoder-decoder hierarchical architecture called D-Former for 3D medical image segmentation. Experiments on the Synapse and ACDC datasets show that our D-Former model, trained from scratch, outperforms various competitive CNN-based or Transformer-based segmentation models at a low computational cost without time-consuming per-training process.

Recent advances in 3D X-ray Computed Tomographic (CT) sensors have stimulated research efforts to unveil the extremely complex micro-scale processes that control the activity of soil microorganisms. Voxel-based description (up to hundreds millions voxels) of the pore space can be extracted, from grey level 3D CT scanner images, by means of simple image processing tools. Classical methods for numerical simulation of biological dynamics using mesh of voxels, such as Lattice Boltzmann Model (LBM), are too much time consuming. Thus, the use of more compact and reliable geometrical representations of pore space can drastically decrease the computational cost of the simulations. Several recent works propose basic analytic volume primitives (e.g. spheres, generalized cylinders, ellipsoids) to define a piece-wise approximation of pore space for numerical simulation of draining, diffusion and microbial decomposition. Such approaches work well but the drawback is that it generates approximation errors. In the present work, we study another alternative where pore space is described by means of geometrically relevant connected subsets of voxels (regions) computed from the curvilinear skeleton. Indeed, many works use the curvilinear skeleton (3D medial axis) for analyzing and partitioning 3D shapes within various domains (medicine, material sciences, petroleum engineering, etc.) but only a few ones in soil sciences. Within the context of soil sciences, most studies dealing with 3D medial axis focus on the determination of pore throats. Here, we segment pore space using curvilinear skeleton in order to achieve numerical simulation of microbial decomposition (including diffusion processes). We validate simulation outputs by comparison with other methods using different pore space geometrical representations (balls, voxels).

We present Shap-MeD, a text-to-3D object generative model specialized in the biomedical domain. The objective of this study is to develop an assistant that facilitates the 3D modeling of medical objects, thereby reducing development time. 3D modeling in medicine has various applications, including surgical procedure simulation and planning, the design of personalized prosthetic implants, medical education, the creation of anatomical models, and the development of research prototypes. To achieve this, we leverage Shap-e, an open-source text-to-3D generative model developed by OpenAI, and fine-tune it using a dataset of biomedical objects. Our model achieved a mean squared error (MSE) of 0.089 in latent generation on the evaluation set, compared to Shap-e's MSE of 0.147. Additionally, we conducted a qualitative evaluation, comparing our model with others in the generation of biomedical objects. Our results indicate that Shap-MeD demonstrates higher structural accuracy in biomedical object generation.

Current self-supervised learning methods for 3D medical imaging rely on simple pretext formulations and organ- or modality-specific datasets, limiting their generalizability and scalability. We present 3DINO, a cutting-edge SSL method adapted to 3D datasets, and use it to pretrain 3DINO-ViT: a general-purpose medical imaging model, on an exceptionally large, multimodal, and multi-organ dataset of ~100,000 3D medical imaging scans from over 10 organs. We validate 3DINO-ViT using extensive experiments on numerous medical imaging segmentation and classification tasks. Our results demonstrate that 3DINO-ViT generalizes across modalities and organs, including out-of-distribution tasks and datasets, outperforming state-of-the-art methods on the majority of evaluation metrics and labeled dataset sizes. Our 3DINO framework and 3DINO-ViT will be made available to enable research on 3D foundation models or further finetuning for a wide range of medical imaging applications.

In this study, we aim to initiate the development of Radiology Foundation Model, termed as RadFM.We consider the construction of foundational models from the perspectives of data, model design, and evaluation thoroughly. Our contribution can be concluded as follows: (i), we construct a large-scale Medical Multi-modal Dataset, MedMD, consisting of 16M 2D and 3D medical scans. To the best of our knowledge, this is the first multi-modal dataset containing 3D medical scans. (ii), We propose an architecture that enables visually conditioned generative pre-training, allowing for the integration of text input interleaved with 2D or 3D medical scans to generate response for diverse radiologic tasks. The model was initially pre-trained on MedMD and subsequently domain-specific fine-tuned on RadMD, a radiologic cleaned version of MedMD, containing 3M radiologic visual-language pairs. (iii), we propose a new evaluation benchmark that comprises five tasks, aiming to comprehensively assess the capability of foundation models in handling practical clinical problems. Our experimental results confirm that RadFM significantly outperforms existing multi-modal foundation models. The codes, data, and model checkpoint will all be made publicly available to promote further research and development in the field.

Existing volumetric medical image segmentation models are typically task-specific, excelling at specific target but struggling to generalize across anatomical structures or modalities. This limitation restricts their broader clinical use. In this paper, we introduce SAM-Med3D for general-purpose segmentation on volumetric medical images. Given only a few 3D prompt points, SAM-Med3D can accurately segment diverse anatomical structures and lesions across various modalities. To achieve this, we gather and process a large-scale 3D medical image dataset, SA-Med3D-140K, from a blend of public sources and licensed private datasets. This dataset includes 22K 3D images and 143K corresponding 3D masks. Then SAM-Med3D, a promptable segmentation model characterized by the fully learnable 3D structure, is trained on this dataset using a two-stage procedure and exhibits impressive performance on both seen and unseen segmentation targets. We comprehensively evaluate SAM-Med3D on 16 datasets covering diverse medical scenarios, including different anatomical structures, modalities, targets, and zero-shot transferability to new/unseen tasks. The evaluation shows the efficiency and efficacy of SAM-Med3D, as well as its promising application to diverse downstream tasks as a pre-trained model. Our approach demonstrates that substantial medical resources can be utilized to develop a general-purpose medical AI for various potential applications. Our dataset, code, and models are available at https://github.com/uni-medical/SAM-Med3D.

Multi-modal three-dimensional (3D) medical imaging data, derived from ultrasound, magnetic resonance imaging (MRI), and potentially computed tomography (CT), provide a widely adopted approach for non-invasive anatomical visualization. Accurate modeling, registration, and visualization in this setting depend on surface reconstruction and frame-to-frame interpolation. Traditional methods often face limitations due to image noise and incomplete information between frames. To address these challenges, we present MedGS, a semi-supervised neural implicit surface reconstruction framework that employs a Gaussian Splatting (GS)-based interpolation mechanism. In this framework, medical imaging data are represented as consecutive two-dimensional (2D) frames embedded in 3D space and modeled using Gaussian-based distributions. This representation enables robust frame interpolation and high-fidelity surface reconstruction across imaging modalities. As a result, MedGS offers more efficient training than traditional neural implicit methods. Its explicit GS-based representation enhances noise robustness, allows flexible editing, and supports precise modeling of complex anatomical structures with fewer artifacts. These features make MedGS highly suitable for scalable and practical applications in medical imaging.

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

Medical imaging datasets often vary due to differences in acquisition protocols, patient demographics, and imaging devices. These variations in data distribution, known as domain shift, present a significant challenge in adapting imaging analysis models for practical healthcare applications. Most current domain adaptation (DA) approaches aim either to align the distributions between the source and target domains or to learn an invariant feature space that generalizes well across all domains. However, both strategies require access to a sufficient number of examples, though not necessarily annotated, from the test domain during training. This limitation hinders the widespread deployment of models in clinical settings, where target domain data may only be accessible in real time. In this work, we introduce HyDA, a novel hypernetwork framework that leverages domain characteristics rather than suppressing them, enabling dynamic adaptation at inference time. Specifically, HyDA learns implicit domain representations and uses them to adjust model parameters on-the-fly, effectively interpolating to unseen domains. We validate HyDA on two clinically relevant applications - MRI brain age prediction and chest X-ray pathology classification - demonstrating its ability to generalize across tasks and modalities. Our code is available at TBD.

The burgeoning integration of 3D medical imaging into healthcare has led to a substantial increase in the workload of medical professionals. To assist clinicians in their diagnostic processes and alleviate their workload, the development of a robust system for retrieving similar case studies presents a viable solution. While the concept holds great promise, the field of 3D medical text-image retrieval is currently limited by the absence of robust evaluation benchmarks and curated datasets. To remedy this, our study presents a groundbreaking dataset, BIMCV-R (This dataset will be released upon acceptance.), which includes an extensive collection of 8,069 3D CT volumes, encompassing over 2 million slices, paired with their respective radiological reports. Expanding upon the foundational work of our dataset, we craft a retrieval strategy, MedFinder. This approach employs a dual-stream network architecture, harnessing the potential of large language models to advance the field of medical image retrieval beyond existing text-image retrieval solutions. It marks our preliminary step towards developing a system capable of facilitating text-to-image, image-to-text, and keyword-based retrieval tasks.

Medical image analysis is essential to clinical diagnosis and treatment, which is increasingly supported by multi-modal large language models (MLLMs). However, previous research has primarily focused on 2D medical images, leaving 3D images under-explored, despite their richer spatial information. This paper aims to advance 3D medical image analysis with MLLMs. To this end, we present a large-scale 3D multi-modal medical dataset, M3D-Data, comprising 120K image-text pairs and 662K instruction-response pairs specifically tailored for various 3D medical tasks, such as image-text retrieval, report generation, visual question answering, positioning, and segmentation. Additionally, we propose M3D-LaMed, a versatile multi-modal large language model for 3D medical image analysis. Furthermore, we introduce a new 3D multi-modal medical benchmark, M3D-Bench, which facilitates automatic evaluation across eight tasks. Through comprehensive evaluation, our method proves to be a robust model for 3D medical image analysis, outperforming existing solutions. All code, data, and models are publicly available at: https://github.com/BAAI-DCAI/M3D.

Current volumetric biomedical foundation models struggle to generalize as public 3D datasets are small and do not cover the broad diversity of medical procedures, conditions, anatomical regions, and imaging protocols. We address this by creating a representation learning method that instead anticipates strong domain shifts at training time itself. We first propose a data engine that synthesizes highly variable training samples that would enable generalization to new biomedical contexts. To then train a single 3D network for any voxel-level task, we develop a contrastive learning method that pretrains the network to be stable against nuisance imaging variation simulated by the data engine, a key inductive bias for generalization. This network's features can be used as robust representations of input images for downstream tasks and its weights provide a strong, dataset-agnostic initialization for finetuning on new datasets. As a result, we set new standards across both multimodality registration and few-shot segmentation, a first for any 3D biomedical vision model, all without (pre-)training on any existing dataset of real images.

In the medical domain, the lack of large training data sets and benchmarks is often a limiting factor for training deep neural networks. In contrast to expensive manual labeling, computer simulations can generate large and fully labeled data sets with a minimum of manual effort. However, models that are trained on simulated data usually do not translate well to real scenarios. To bridge the domain gap between simulated and real laparoscopic images, we exploit recent advances in unpaired image-to-image translation. We extent an image-to-image translation method to generate a diverse multitude of realistically looking synthetic images based on images from a simple laparoscopy simulation. By incorporating means to ensure that the image content is preserved during the translation process, we ensure that the labels given for the simulated images remain valid for their realistically looking translations. This way, we are able to generate a large, fully labeled synthetic data set of laparoscopic images with realistic appearance. We show that this data set can be used to train models for the task of liver segmentation of laparoscopic images. We achieve average dice scores of up to 0.89 in some patients without manually labeling a single laparoscopic image and show that using our synthetic data to pre-train models can greatly improve their performance. The synthetic data set will be made publicly available, fully labeled with segmentation maps, depth maps, normal maps, and positions of tools and camera (http://opencas.dkfz.de/image2image).

With the rapid advance of computer graphics and artificial intelligence technologies, the ways we interact with the world have undergone a transformative shift. Virtual Reality (VR) technology, aided by artificial intelligence (AI), has emerged as a dominant interaction media in multiple application areas, thanks to its advantage of providing users with immersive experiences. Among those applications, medicine is considered one of the most promising areas. In this paper, we present a comprehensive examination of the burgeoning field of AI-enhanced VR applications in medical care and services. By introducing a systematic taxonomy, we meticulously classify the pertinent techniques and applications into three well-defined categories based on different phases of medical diagnosis and treatment: Visualization Enhancement, VR-related Medical Data Processing, and VR-assisted Intervention. This categorization enables a structured exploration of the diverse roles that AI-powered VR plays in the medical domain, providing a framework for a more comprehensive understanding and evaluation of these technologies. To our best knowledge, this is the first systematic survey of AI-powered VR systems in medical settings, laying a foundation for future research in this interdisciplinary domain.

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

Many clinical tasks require an understanding of specialized data, such as medical images and genomics, which is not typically found in general-purpose large multimodal models. Building upon Gemini's multimodal models, we develop several models within the new Med-Gemini family that inherit core capabilities of Gemini and are optimized for medical use via fine-tuning with 2D and 3D radiology, histopathology, ophthalmology, dermatology and genomic data. Med-Gemini-2D sets a new standard for AI-based chest X-ray (CXR) report generation based on expert evaluation, exceeding previous best results across two separate datasets by an absolute margin of 1% and 12%, where 57% and 96% of AI reports on normal cases, and 43% and 65% on abnormal cases, are evaluated as "equivalent or better" than the original radiologists' reports. We demonstrate the first ever large multimodal model-based report generation for 3D computed tomography (CT) volumes using Med-Gemini-3D, with 53% of AI reports considered clinically acceptable, although additional research is needed to meet expert radiologist reporting quality. Beyond report generation, Med-Gemini-2D surpasses the previous best performance in CXR visual question answering (VQA) and performs well in CXR classification and radiology VQA, exceeding SoTA or baselines on 17 of 20 tasks. In histopathology, ophthalmology, and dermatology image classification, Med-Gemini-2D surpasses baselines across 18 out of 20 tasks and approaches task-specific model performance. Beyond imaging, Med-Gemini-Polygenic outperforms the standard linear polygenic risk score-based approach for disease risk prediction and generalizes to genetically correlated diseases for which it has never been trained. Although further development and evaluation are necessary in the safety-critical medical domain, our results highlight the potential of Med-Gemini across a wide range of medical tasks.

Developing 3D vision-language models with robust clinical reasoning remains a challenge due to the inherent complexity of volumetric medical imaging, the tendency of models to overfit superficial report patterns, and the lack of interpretability-aware reward designs. In this paper, we propose Med3D-R1, a reinforcement learning framework with a two-stage training process: Supervised Fine-Tuning (SFT) and Reinforcement Learning (RL). During SFT stage, we introduce a residual alignment mechanism to bridge the gap between high-dimensional 3D features and textual embeddings, and an abnormality re-weighting strategy to emphasize clinically informative tokens and reduce structural bias in reports. In RL stage, we redesign the consistency reward to explicitly promote coherent, step-by-step diagnostic reasoning. We evaluate our method on medical multiple-choice visual question answering using two 3D diagnostic benchmarks, CT-RATE and RAD-ChestCT, where our model attains state-of-the-art accuracies of 41.92\% on CT-RATE and 44.99\% on RAD-ChestCT. These results indicate improved abnormality diagnosis and clinical reasoning and outperform prior methods on both benchmarks. Overall, our approach holds promise for enhancing real-world diagnostic workflows by enabling more reliable and transparent 3D medical vision-language systems.

Generalist vision language models (VLMs) have made significant strides in computer vision, but they fall short in specialized fields like healthcare, where expert knowledge is essential. In traditional computer vision tasks, creative or approximate answers may be acceptable, but in healthcare, precision is paramount.Current large multimodal models like Gemini and GPT-4o are insufficient for medical tasks due to their reliance on memorized internet knowledge rather than the nuanced expertise required in healthcare. VLMs are usually trained in three stages: vision pre-training, vision-language pre-training, and instruction fine-tuning (IFT). IFT has been typically applied using a mixture of generic and healthcare data. In contrast, we propose that for medical VLMs, a fourth stage of specialized IFT is necessary, which focuses on medical data and includes information from domain expert models. Domain expert models developed for medical use are crucial because they are specifically trained for certain clinical tasks, e.g. to detect tumors and classify abnormalities through segmentation and classification, which learn fine-grained features of medical data-features that are often too intricate for a VLM to capture effectively especially in radiology. This paper introduces a new framework, VILA-M3, for medical VLMs that utilizes domain knowledge via expert models. Through our experiments, we show an improved state-of-the-art (SOTA) performance with an average improvement of ~9% over the prior SOTA model Med-Gemini and ~6% over models trained on the specific tasks. Our approach emphasizes the importance of domain expertise in creating precise, reliable VLMs for medical applications.

Medical Visual Question Answering (Med-VQA) holds significant potential for clinical decision support, yet existing efforts primarily focus on 2D imaging with limited task diversity. This paper presents 3D-RAD, a large-scale dataset designed to advance 3D Med-VQA using radiology CT scans. The 3D-RAD dataset encompasses six diverse VQA tasks: anomaly detection, image observation, medical computation, existence detection, static temporal diagnosis, and longitudinal temporal diagnosis. It supports both open- and closed-ended questions while introducing complex reasoning challenges, including computational tasks and multi-stage temporal analysis, to enable comprehensive benchmarking. Extensive evaluations demonstrate that existing vision-language models (VLMs), especially medical VLMs exhibit limited generalization, particularly in multi-temporal tasks, underscoring the challenges of real-world 3D diagnostic reasoning. To drive future advancements, we release a high-quality training set 3D-RAD-T of 136,195 expert-aligned samples, showing that fine-tuning on this dataset could significantly enhance model performance. Our dataset and code, aiming to catalyze multimodal medical AI research and establish a robust foundation for 3D medical visual understanding, are publicly available at https://github.com/Tang-xiaoxiao/3D-RAD.

The integration of artificial intelligence in image-guided interventions holds transformative potential, promising to extract 3D geometric and quantitative information from conventional 2D imaging modalities during complex procedures. Achieving this requires the rapid and precise alignment of 2D intraoperative images (e.g., X-ray) with 3D preoperative volumes (e.g., CT, MRI). However, current 2D/3D registration methods fail across the broad spectrum of procedures dependent on X-ray guidance: traditional optimization techniques require custom parameter tuning for each subject, whereas neural networks trained on small datasets do not generalize to new patients or require labor-intensive manual annotations, increasing clinical burden and precluding application to new anatomical targets. To address these challenges, we present xvr, a fully automated framework for training patient-specific neural networks for 2D/3D registration. xvr uses physics-based simulation to generate abundant high-quality training data from a patient's own preoperative volumetric imaging, thereby overcoming the inherently limited ability of supervised models to generalize to new patients and procedures. Furthermore, xvr requires only 5 minutes of training per patient, making it suitable for emergency interventions as well as planned procedures. We perform the largest evaluation of a 2D/3D registration algorithm on real X-ray data to date and find that xvr robustly generalizes across a diverse dataset comprising multiple anatomical structures, imaging modalities, and hospitals. Across surgical tasks, xvr achieves submillimeter-accurate registration at intraoperative speeds, improving upon existing methods by an order of magnitude. xvr is released as open-source software freely available at https://github.com/eigenvivek/xvr.

The field of self-supervised learning (SSL) for 3D medical images lacks consistency and standardization. While many methods have been developed, it is impossible to identify the current state-of-the-art, due to i) varying and small pretraining datasets, ii) varying architectures, and iii) being evaluated on differing downstream datasets. In this paper, we bring clarity to this field and lay the foundation for further method advancements through three key contributions: We a) publish the largest publicly available pre-training dataset comprising 114k 3D brain MRI volumes, enabling all practitioners to pre-train on a large-scale dataset. We b) benchmark existing 3D self-supervised learning methods on this dataset for a state-of-the-art CNN and Transformer architecture, clarifying the state of 3D SSL pre-training. Among many findings, we show that pre-trained methods can exceed a strong from-scratch nnU-Net ResEnc-L baseline. Lastly, we c) publish the code of our pre-training and fine-tuning frameworks and provide the pre-trained models created during the benchmarking process to facilitate rapid adoption and reproduction.

Synthetic medical data offers a scalable solution for training robust models, but significant domain gaps limit its generalizability to real-world clinical settings. This paper addresses the challenge of cross-domain translation between synthetic and real X-ray images of the head, focusing on bridging discrepancies in attenuation behavior, noise characteristics, and soft tissue representation. We propose MedShift, a unified class-conditional generative model based on Flow Matching and Schrodinger Bridges, which enables high-fidelity, unpaired image translation across multiple domains. Unlike prior approaches that require domain-specific training or rely on paired data, MedShift learns a shared domain-agnostic latent space and supports seamless translation between any pair of domains seen during training. We introduce X-DigiSkull, a new dataset comprising aligned synthetic and real skull X-rays under varying radiation doses, to benchmark domain translation models. Experimental results demonstrate that, despite its smaller model size compared to diffusion-based approaches, MedShift offers strong performance and remains flexible at inference time, as it can be tuned to prioritize either perceptual fidelity or structural consistency, making it a scalable and generalizable solution for domain adaptation in medical imaging. The code and dataset are available at https://caetas.github.io/medshift.html

Radiologic diagnostic errors-under-reading errors, inattentional blindness, and communication failures-remain prevalent in clinical practice. These issues often stem from missed localized abnormalities, limited global context, and variability in report language. These challenges are amplified in 3D imaging, where clinicians must examine hundreds of slices per scan. Addressing them requires systems with precise localized detection, global volume-level reasoning, and semantically consistent natural language reporting. However, existing 3D vision-language models are unable to meet all three needs jointly, lacking local-global understanding for spatial reasoning and struggling with the variability and noise of uncurated radiology reports. We present MedVista3D, a multi-scale semantic-enriched vision-language pretraining framework for 3D CT analysis. To enable joint disease detection and holistic interpretation, MedVista3D performs local and global image-text alignment for fine-grained representation learning within full-volume context. To address report variability, we apply language model rewrites and introduce a Radiology Semantic Matching Bank for semantics-aware alignment. MedVista3D achieves state-of-the-art performance on zero-shot disease classification, report retrieval, and medical visual question answering, while transferring well to organ segmentation and prognosis prediction. Code and datasets will be released.

Current Vision-Language Models (VLMs) struggle to ground anatomical regions in 3D medical images and reason about them in a step-by-step manner, a key requirement of real-world diagnostic assessment. This ability is essential for aligning model outputs with the diagnostic workflows clinicians use in practice, enabling trustworthy clinician-AI collaboration. Existing 3D datasets provide localization labels, but none support this "grounded reasoning" ability. To address this gap, we introduce 3DReasonKnee, the first 3D grounded reasoning dataset for medical images, which provides 494k high-quality quintuples derived from 7,970 3D knee MRI volumes. Each quintuple includes: (1) the 3D MRI volume, (2) a diagnostic question targeting a specific anatomical region (3) a 3D bounding box localizing the relevant anatomical structures, (4) clinician-generated diagnostic reasoning steps that explicitly detail the 3D reasoning process, and (5) structured severity assessments for the relevant anatomical region. The creation and validation of 3DReasonKnee, involving over 450 hours of expert clinician time for manually segmenting MRIs and generating reasoning chains, ensures its superior quality and clinical relevance. We establish ReasonKnee-Bench to evaluate localization and diagnostic accuracy, providing insight into VLM ability to perform grounding and severity assessment across anatomical regions and diagnostic inquiries. We benchmark five state-of-the-art VLMs, providing baseline performance for ReasonKnee-Bench. By providing this unique resource of expert-annotated 3D reasoning pathways, 3DReasonKnee serves as a repository of orthopedic surgeons' diagnostic expertise and offers a vital testbed for advancing multimodal medical AI systems towards 3D, clinically aligned, localized decision-making capabilities. The dataset can be found in: https://huggingface.co/datasets/rajpurkarlab/3DReasonKnee

Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional diversity could mitigate the existing paucity of high-quality, annotated medical imaging datasets. In this work, we develop a strategy to overcome the large natural-medical distributional shift by adapting a pre-trained latent diffusion model on a corpus of publicly available chest x-rays (CXR) and their corresponding radiology (text) reports. We investigate the model's ability to generate high-fidelity, diverse synthetic CXR conditioned on text prompts. We assess the model outputs quantitatively using image quality metrics, and evaluate image quality and text-image alignment by human domain experts. We present evidence that the resulting model (RoentGen) is able to create visually convincing, diverse synthetic CXR images, and that the output can be controlled to a new extent by using free-form text prompts including radiology-specific language. Fine-tuning this model on a fixed training set and using it as a data augmentation method, we measure a 5% improvement of a classifier trained jointly on synthetic and real images, and a 3% improvement when trained on a larger but purely synthetic training set. Finally, we observe that this fine-tuning distills in-domain knowledge in the text-encoder and can improve its representation capabilities of certain diseases like pneumothorax by 25%.

Large Language Models (LLMs) constitute a breakthrough state-of-the-art Artificial Intelligence (AI) technology which is rapidly evolving and promises to aid in medical diagnosis either by assisting doctors or by simulating a doctor's workflow in more advanced and complex implementations. In this technical paper, we outline Cognitive Network Evaluation Toolkit for Medical Domains (COGNET-MD), which constitutes a novel benchmark for LLM evaluation in the medical domain. Specifically, we propose a scoring-framework with increased difficulty to assess the ability of LLMs in interpreting medical text. The proposed framework is accompanied with a database of Multiple Choice Quizzes (MCQs). To ensure alignment with current medical trends and enhance safety, usefulness, and applicability, these MCQs have been constructed in collaboration with several associated medical experts in various medical domains and are characterized by varying degrees of difficulty. The current (first) version of the database includes the medical domains of Psychiatry, Dentistry, Pulmonology, Dermatology and Endocrinology, but it will be continuously extended and expanded to include additional medical domains.

With the growing volume of CT examinations, there is an increasing demand for automated tools such as organ segmentation, abnormality detection, and report generation to support radiologists in managing their clinical workload. Multi-label classification of 3D Chest CT scans remains a critical yet challenging problem due to the complex spatial relationships inherent in volumetric data and the wide variability of abnormalities. Existing methods based on 3D convolutional neural networks struggle to capture long-range dependencies, while Vision Transformers often require extensive pre-training on large-scale, domain-specific datasets to perform competitively. In this work of academic research, we propose a 2.5D alternative by introducing a new graph-based framework that represents 3D CT volumes as structured graphs, where axial slice triplets serve as nodes processed through spectral graph convolution, enabling the model to reason over inter-slice dependencies while maintaining complexity compatible with clinical deployment. Our method, trained and evaluated on 3 datasets from independent institutions, achieves strong cross-dataset generalization, and shows competitive performance compared to state-of-the-art visual encoders. We further conduct comprehensive ablation studies to evaluate the impact of various aggregation strategies, edge-weighting schemes, and graph connectivity patterns. Additionally, we demonstrate the broader applicability of our approach through transfer experiments on automated radiology report generation and abdominal CT data.

The limited availability of 3D medical image datasets, due to privacy concerns and high collection or annotation costs, poses significant challenges in the field of medical imaging. While a promising alternative is the use of synthesized medical data, there are few solutions for realistic 3D medical image synthesis due to difficulties in backbone design and fewer 3D training samples compared to 2D counterparts. In this paper, we propose GEM-3D, a novel generative approach to the synthesis of 3D medical images and the enhancement of existing datasets using conditional diffusion models. Our method begins with a 2D slice, noted as the informed slice to serve the patient prior, and propagates the generation process using a 3D segmentation mask. By decomposing the 3D medical images into masks and patient prior information, GEM-3D offers a flexible yet effective solution for generating versatile 3D images from existing datasets. GEM-3D can enable dataset enhancement by combining informed slice selection and generation at random positions, along with editable mask volumes to introduce large variations in diffusion sampling. Moreover, as the informed slice contains patient-wise information, GEM-3D can also facilitate counterfactual image synthesis and dataset-level de-enhancement with desired control. Experiments on brain MRI and abdomen CT images demonstrate that GEM-3D is capable of synthesizing high-quality 3D medical images with volumetric consistency, offering a straightforward solution for dataset enhancement during inference. The code is available at https://github.com/HKU-MedAI/GEM-3D.

Synthetic medical data generation has opened up new possibilities in the healthcare domain, offering a powerful tool for simulating clinical scenarios, enhancing diagnostic and treatment quality, gaining granular medical knowledge, and accelerating the development of unbiased algorithms. In this context, we present a novel approach called ViewXGen, designed to overcome the limitations of existing methods that rely on general domain pipelines using only radiology reports to generate frontal-view chest X-rays. Our approach takes into consideration the diverse view positions found in the dataset, enabling the generation of chest X-rays with specific views, which marks a significant advancement in the field. To achieve this, we introduce a set of specially designed tokens for each view position, tailoring the generation process to the user's preferences. Furthermore, we leverage multi-view chest X-rays as input, incorporating valuable information from different views within the same study. This integration rectifies potential errors and contributes to faithfully capturing abnormal findings in chest X-ray generation. To validate the effectiveness of our approach, we conducted statistical analyses, evaluating its performance in a clinical efficacy metric on the MIMIC-CXR dataset. Also, human evaluation demonstrates the remarkable capabilities of ViewXGen, particularly in producing realistic view-specific X-rays that closely resemble the original images.

Acquiring and annotating sufficient labeled data is crucial in developing accurate and robust learning-based models, but obtaining such data can be challenging in many medical image segmentation tasks. One promising solution is to synthesize realistic data with ground-truth mask annotations. However, no prior studies have explored generating complete 3D volumetric images with masks. In this paper, we present MedGen3D, a deep generative framework that can generate paired 3D medical images and masks. First, we represent the 3D medical data as 2D sequences and propose the Multi-Condition Diffusion Probabilistic Model (MC-DPM) to generate multi-label mask sequences adhering to anatomical geometry. Then, we use an image sequence generator and semantic diffusion refiner conditioned on the generated mask sequences to produce realistic 3D medical images that align with the generated masks. Our proposed framework guarantees accurate alignment between synthetic images and segmentation maps. Experiments on 3D thoracic CT and brain MRI datasets show that our synthetic data is both diverse and faithful to the original data, and demonstrate the benefits for downstream segmentation tasks. We anticipate that MedGen3D's ability to synthesize paired 3D medical images and masks will prove valuable in training deep learning models for medical imaging tasks.

This paper explores the advancements and applications of large-scale models in the medical field, with a particular focus on Medical Large Models (MedLMs). These models, encompassing Large Language Models (LLMs), Vision Models, 3D Large Models, and Multimodal Models, are revolutionizing healthcare by enhancing disease prediction, diagnostic assistance, personalized treatment planning, and drug discovery. The integration of graph neural networks in medical knowledge graphs and drug discovery highlights the potential of Large Graph Models (LGMs) in understanding complex biomedical relationships. The study also emphasizes the transformative role of Vision-Language Models (VLMs) and 3D Large Models in medical image analysis, anatomical modeling, and prosthetic design. Despite the challenges, these technologies are setting new benchmarks in medical innovation, improving diagnostic accuracy, and paving the way for personalized healthcare solutions. This paper aims to provide a comprehensive overview of the current state and future directions of large models in medicine, underscoring their significance in advancing global health.

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

The medical domain is vast and diverse, with many existing embedding models focused on general healthcare applications. However, these models often struggle to capture a deep understanding of diseases due to their broad generalization across the entire medical field. To address this gap, I present DisEmbed, a disease-focused embedding model. DisEmbed is trained on a synthetic dataset specifically curated to include disease descriptions, symptoms, and disease-related Q\&A pairs, making it uniquely suited for disease-related tasks. For evaluation, I benchmarked DisEmbed against existing medical models using disease-specific datasets and the triplet evaluation method. My results demonstrate that DisEmbed outperforms other models, particularly in identifying disease-related contexts and distinguishing between similar diseases. This makes DisEmbed highly valuable for disease-specific use cases, including retrieval-augmented generation (RAG) tasks, where its performance is particularly robust.

Every day, countless surgeries are performed worldwide, each within the distinct settings of operating rooms (ORs) that vary not only in their setups but also in the personnel, tools, and equipment used. This inherent diversity poses a substantial challenge for achieving a holistic understanding of the OR, as it requires models to generalize beyond their initial training datasets. To reduce this gap, we introduce ORacle, an advanced vision-language model designed for holistic OR domain modeling, which incorporates multi-view and temporal capabilities and can leverage external knowledge during inference, enabling it to adapt to previously unseen surgical scenarios. This capability is further enhanced by our novel data augmentation framework, which significantly diversifies the training dataset, ensuring ORacle's proficiency in applying the provided knowledge effectively. In rigorous testing, in scene graph generation, and downstream tasks on the 4D-OR dataset, ORacle not only demonstrates state-of-the-art performance but does so requiring less data than existing models. Furthermore, its adaptability is displayed through its ability to interpret unseen views, actions, and appearances of tools and equipment. This demonstrates ORacle's potential to significantly enhance the scalability and affordability of OR domain modeling and opens a pathway for future advancements in surgical data science. We will release our code and data upon acceptance.

Recent developments in Large Language Model (LLM)-based agents have shown impressive capabilities spanning multiple domains, exemplified by deep research systems that demonstrate superior performance on complex information-seeking and synthesis tasks. While general-purpose deep research agents have shown impressive capabilities, they struggle significantly with medical domain challenges, as evidenced by leading proprietary systems achieving limited accuracy on complex medical benchmarks. The key limitations are: (1) the model lacks sufficient dense medical knowledge for clinical reasoning, and (2) the framework is constrained by the absence of specialized retrieval tools tailored for medical contexts.We present a medical deep research agent that addresses these challenges through two core innovations. First, we develop a novel data synthesis framework using medical knowledge graphs, extracting the longest chains from subgraphs around rare medical entities to generate complex multi-hop question-answer pairs. Second, we integrate a custom-built private medical retrieval engine alongside general-purpose tools, enabling accurate medical information synthesis. Our approach generates 2100+ diverse trajectories across 12 medical specialties, each averaging 4.2 tool interactions.Through a two-stage training paradigm combining supervised fine-tuning and online reinforcement learning with composite rewards, our MedResearcher-R1-32B model demonstrates exceptional performance, establishing new state-of-the-art results on medical benchmarks while maintaining competitive performance on general deep research tasks. Our work demonstrates that strategic domain-specific innovations in architecture, tool design, and training data construction can enable smaller open-source models to outperform much larger proprietary systems in specialized domains.

Recent advancements in Large Multimodal Models (LMMs) have attracted interest in their generalization capability with only a few samples in the prompt. This progress is particularly relevant to the medical domain, where the quality and sensitivity of data pose unique challenges for model training and application. However, the dependency on high-quality data for effective in-context learning raises questions about the feasibility of these models when encountering with the inevitable variations and errors inherent in real-world medical data. In this paper, we introduce MID-M, a novel framework that leverages the in-context learning capabilities of a general-domain Large Language Model (LLM) to process multimodal data via image descriptions. MID-M achieves a comparable or superior performance to task-specific fine-tuned LMMs and other general-domain ones, without the extensive domain-specific training or pre-training on multimodal data, with significantly fewer parameters. This highlights the potential of leveraging general-domain LLMs for domain-specific tasks and offers a sustainable and cost-effective alternative to traditional LMM developments. Moreover, the robustness of MID-M against data quality issues demonstrates its practical utility in real-world medical domain applications.

We present MInDI-3D (Medical Inversion by Direct Iteration in 3D), the first 3D conditional diffusion-based model for real-world sparse-view Cone Beam Computed Tomography (CBCT) artefact removal, aiming to reduce imaging radiation exposure. A key contribution is extending the "InDI" concept from 2D to a full 3D volumetric approach for medical images, implementing an iterative denoising process that refines the CBCT volume directly from sparse-view input. A further contribution is the generation of a large pseudo-CBCT dataset (16,182) from chest CT volumes of the CT-RATE public dataset to robustly train MInDI-3D. We performed a comprehensive evaluation, including quantitative metrics, scalability analysis, generalisation tests, and a clinical assessment by 11 clinicians. Our results show MInDI-3D's effectiveness, achieving a 12.96 (6.10) dB PSNR gain over uncorrected scans with only 50 projections on the CT-RATE pseudo-CBCT (independent real-world) test set and enabling an 8x reduction in imaging radiation exposure. We demonstrate its scalability by showing that performance improves with more training data. Importantly, MInDI-3D matches the performance of a 3D U-Net on real-world scans from 16 cancer patients across distortion and task-based metrics. It also generalises to new CBCT scanner geometries. Clinicians rated our model as sufficient for patient positioning across all anatomical sites and found it preserved lung tumour boundaries well.

The advent of large-scale vision foundation models, pre-trained on diverse natural images, has marked a paradigm shift in computer vision. However, how the frontier vision foundation models' efficacies transfer to specialized domains remains such as medical imaging remains an open question. This report investigates whether DINOv3, a state-of-the-art self-supervised vision transformer (ViT) that features strong capability in dense prediction tasks, can directly serve as a powerful, unified encoder for medical vision tasks without domain-specific pre-training. To answer this, we benchmark DINOv3 across common medical vision tasks, including 2D/3D classification and segmentation on a wide range of medical imaging modalities. We systematically analyze its scalability by varying model sizes and input image resolutions. Our findings reveal that DINOv3 shows impressive performance and establishes a formidable new baseline. Remarkably, it can even outperform medical-specific foundation models like BiomedCLIP and CT-Net on several tasks, despite being trained solely on natural images. However, we identify clear limitations: The model's features degrade in scenarios requiring deep domain specialization, such as in Whole-Slide Pathological Images (WSIs), Electron Microscopy (EM), and Positron Emission Tomography (PET). Furthermore, we observe that DINOv3 does not consistently obey scaling law in the medical domain; performance does not reliably increase with larger models or finer feature resolutions, showing diverse scaling behaviors across tasks. Ultimately, our work establishes DINOv3 as a strong baseline, whose powerful visual features can serve as a robust prior for multiple complex medical tasks. This opens promising future directions, such as leveraging its features to enforce multiview consistency in 3D reconstruction.

In this paper, we consider enhancing medical visual-language pre-training (VLP) with domain-specific knowledge, by exploiting the paired image-text reports from the radiological daily practice. In particular, we make the following contributions: First, unlike existing works that directly process the raw reports, we adopt a novel triplet extraction module to extract the medical-related information, avoiding unnecessary complexity from language grammar and enhancing the supervision signals; Second, we propose a novel triplet encoding module with entity translation by querying a knowledge base, to exploit the rich domain knowledge in medical field, and implicitly build relationships between medical entities in the language embedding space; Third, we propose to use a Transformer-based fusion model for spatially aligning the entity description with visual signals at the image patch level, enabling the ability for medical diagnosis; Fourth, we conduct thorough experiments to validate the effectiveness of our architecture, and benchmark on numerous public benchmarks, e.g., ChestX-ray14, RSNA Pneumonia, SIIM-ACR Pneumothorax, COVIDx CXR-2, COVID Rural, and EdemaSeverity. In both zero-shot and fine-tuning settings, our model has demonstrated strong performance compared with the former methods on disease classification and grounding.

Promptable segmentation foundation models such as SAM3 have demonstrated strong generalization capabilities through interactive and concept-based prompting. However, their direct applicability to medical image segmentation remains limited by severe domain shifts, the absence of privileged spatial prompts, and the need to reason over complex anatomical and volumetric structures. Here we present Medical SAM3, a foundation model for universal prompt-driven medical image segmentation, obtained by fully fine-tuning SAM3 on large-scale, heterogeneous 2D and 3D medical imaging datasets with paired segmentation masks and text prompts. Through a systematic analysis of vanilla SAM3, we observe that its performance degrades substantially on medical data, with its apparent competitiveness largely relying on strong geometric priors such as ground-truth-derived bounding boxes. These findings motivate full model adaptation beyond prompt engineering alone. By fine-tuning SAM3's model parameters on 33 datasets spanning 10 medical imaging modalities, Medical SAM3 acquires robust domain-specific representations while preserving prompt-driven flexibility. Extensive experiments across organs, imaging modalities, and dimensionalities demonstrate consistent and significant performance gains, particularly in challenging scenarios characterized by semantic ambiguity, complex morphology, and long-range 3D context. Our results establish Medical SAM3 as a universal, text-guided segmentation foundation model for medical imaging and highlight the importance of holistic model adaptation for achieving robust prompt-driven segmentation under severe domain shift. Code and model will be made available at https://github.com/AIM-Research-Lab/Medical-SAM3.

The emerging trend of advancing generalist artificial intelligence, such as GPTv4 and Gemini, has reshaped the landscape of research (academia and industry) in machine learning and many other research areas. However, domain-specific applications of such foundation models (e.g., in medicine) remain untouched or often at their very early stages. It will require an individual set of transfer learning and model adaptation techniques by further expanding and injecting these models with domain knowledge and data. The development of such technologies could be largely accelerated if the bundle of data, algorithms, and pre-trained foundation models were gathered together and open-sourced in an organized manner. In this work, we present OpenMEDLab, an open-source platform for multi-modality foundation models. It encapsulates not only solutions of pioneering attempts in prompting and fine-tuning large language and vision models for frontline clinical and bioinformatic applications but also building domain-specific foundation models with large-scale multi-modal medical data. Importantly, it opens access to a group of pre-trained foundation models for various medical image modalities, clinical text, protein engineering, etc. Inspiring and competitive results are also demonstrated for each collected approach and model in a variety of benchmarks for downstream tasks. We welcome researchers in the field of medical artificial intelligence to continuously contribute cutting-edge methods and models to OpenMEDLab, which can be accessed via https://github.com/openmedlab.

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

3D medical image generation is essential for data augmentation and patient privacy, calling for reliable and efficient models suited for clinical practice. However, current methods suffer from limited anatomical fidelity, restricted axial length, and substantial computational cost, placing them beyond reach for regions with limited resources and infrastructure. We introduce TRACE, a framework that generates 3D medical images with spatiotemporal alignment using a 2D multimodal-conditioned diffusion approach. TRACE models sequential 2D slices as video frame pairs, combining segmentation priors and radiology reports for anatomical alignment, incorporating optical flow to sustain temporal coherence. During inference, an overlapping-frame strategy links frame pairs into a flexible length sequence, reconstructed into a spatiotemporally and anatomically aligned 3D volume. Experimental results demonstrate that TRACE effectively balances computational efficiency with preserving anatomical fidelity and spatiotemporal consistency. Code is available at: https://github.com/VinyehShaw/TRACE.

Domain adaptation (DA) has drawn high interest for its capacity to adapt a model trained on labeled source data to perform well on unlabeled or weakly labeled target data from a different domain. Most common DA techniques require concurrent access to the input images of both the source and target domains. However, in practice, privacy concerns often impede the availability of source images in the adaptation phase. This is a very frequent DA scenario in medical imaging, where, for instance, the source and target images could come from different clinical sites. We introduce a source-free domain adaptation for image segmentation. Our formulation is based on minimizing a label-free entropy loss defined over target-domain data, which we further guide with a domain-invariant prior on the segmentation regions. Many priors can be derived from anatomical information. Here, a class ratio prior is estimated from anatomical knowledge and integrated in the form of a Kullback Leibler (KL) divergence in our overall loss function. Furthermore, we motivate our overall loss with an interesting link to maximizing the mutual information between the target images and their label predictions. We show the effectiveness of our prior aware entropy minimization in a variety of domain-adaptation scenarios, with different modalities and applications, including spine, prostate, and cardiac segmentation. Our method yields comparable results to several state of the art adaptation techniques, despite having access to much less information, as the source images are entirely absent in our adaptation phase. Our straightforward adaptation strategy uses only one network, contrary to popular adversarial techniques, which are not applicable to a source-free DA setting. Our framework can be readily used in a breadth of segmentation problems, and our code is publicly available: https://github.com/mathilde-b/SFDA

Collecting large-scale medical datasets with fully annotated samples for training of deep networks is prohibitively expensive, especially for 3D volume data. Recent breakthroughs in self-supervised learning (SSL) offer the ability to overcome the lack of labeled training samples by learning feature representations from unlabeled data. However, most current SSL techniques in the medical field have been designed for either 2D images or 3D volumes. In practice, this restricts the capability to fully leverage unlabeled data from numerous sources, which may include both 2D and 3D data. Additionally, the use of these pre-trained networks is constrained to downstream tasks with compatible data dimensions. In this paper, we propose a novel framework for unsupervised joint learning on 2D and 3D data modalities. Given a set of 2D images or 2D slices extracted from 3D volumes, we construct an SSL task based on a 2D contrastive clustering problem for distinct classes. The 3D volumes are exploited by computing vectored embedding at each slice and then assembling a holistic feature through deformable self-attention mechanisms in Transformer, allowing incorporating long-range dependencies between slices inside 3D volumes. These holistic features are further utilized to define a novel 3D clustering agreement-based SSL task and masking embedding prediction inspired by pre-trained language models. Experiments on downstream tasks, such as 3D brain segmentation, lung nodule detection, 3D heart structures segmentation, and abnormal chest X-ray detection, demonstrate the effectiveness of our joint 2D and 3D SSL approach. We improve plain 2D Deep-ClusterV2 and SwAV by a significant margin and also surpass various modern 2D and 3D SSL approaches.

Humans can develop internal world models that encode common sense knowledge, telling them how the world works and predicting the consequences of their actions. This concept has emerged as a promising direction for establishing general-purpose machine-learning models in recent preliminary works, e.g., for visual representation learning. In this paper, we present CheXWorld, the first effort towards a self-supervised world model for radiographic images. Specifically, our work develops a unified framework that simultaneously models three aspects of medical knowledge essential for qualified radiologists, including 1) local anatomical structures describing the fine-grained characteristics of local tissues (e.g., architectures, shapes, and textures); 2) global anatomical layouts describing the global organization of the human body (e.g., layouts of organs and skeletons); and 3) domain variations that encourage CheXWorld to model the transitions across different appearance domains of radiographs (e.g., varying clarity, contrast, and exposure caused by collecting radiographs from different hospitals, devices, or patients). Empirically, we design tailored qualitative and quantitative analyses, revealing that CheXWorld successfully captures these three dimensions of medical knowledge. Furthermore, transfer learning experiments across eight medical image classification and segmentation benchmarks showcase that CheXWorld significantly outperforms existing SSL methods and large-scale medical foundation models. Code & pre-trained models are available at https://github.com/LeapLabTHU/CheXWorld.

This paper investigates the 3D domain generalization (3DDG) ability of large 3D models based on prevalent prompt learning. Recent works demonstrate the performances of 3D point cloud recognition can be boosted remarkably by parameter-efficient prompt tuning. However, we observe that the improvement on downstream tasks comes at the expense of a severe drop in 3D domain generalization. To resolve this challenge, we present a comprehensive regulation framework that allows the learnable prompts to actively interact with the well-learned general knowledge in large 3D models to maintain good generalization. Specifically, the proposed framework imposes multiple explicit constraints on the prompt learning trajectory by maximizing the mutual agreement between task-specific predictions and task-agnostic knowledge. We design the regulation framework as a plug-and-play module to embed into existing representative large 3D models. Surprisingly, our method not only realizes consistently increasing generalization ability but also enhances task-specific 3D recognition performances across various 3DDG benchmarks by a clear margin. Considering the lack of study and evaluation on 3DDG, we also create three new benchmarks, namely base-to-new, cross-dataset and few-shot generalization benchmarks, to enrich the field and inspire future research. Code and benchmarks are available at https://github.com/auniquesun/Point-PRC.

Recent years have witnessed remarkable advances in artificial intelligence generated content(AIGC), with diverse input modalities, e.g., text, image, video, audio and 3D. The 3D is the most close visual modality to real-world 3D environment and carries enormous knowledge. The 3D content generation shows both academic and practical values while also presenting formidable technical challenges. This review aims to consolidate developments within the burgeoning domain of 3D content generation. Specifically, a new taxonomy is proposed that categorizes existing approaches into three types: 3D native generative methods, 2D prior-based 3D generative methods, and hybrid 3D generative methods. The survey covers approximately 60 papers spanning the major techniques. Besides, we discuss limitations of current 3D content generation techniques, and point out open challenges as well as promising directions for future work. Accompanied with this survey, we have established a project website where the resources on 3D content generation research are provided. The project page is available at https://github.com/hitcslj/Awesome-AIGC-3D.

The integration of neural-network-based systems into clinical practice is limited by challenges related to domain generalization and robustness. The computer vision community established benchmarks such as ImageNet-C as a fundamental prerequisite to measure progress towards those challenges. Similar datasets are largely absent in the medical imaging community which lacks a comprehensive benchmark that spans across imaging modalities and applications. To address this gap, we create and open-source MedMNIST-C, a benchmark dataset based on the MedMNIST+ collection covering 12 datasets and 9 imaging modalities. We simulate task and modality-specific image corruptions of varying severity to comprehensively evaluate the robustness of established algorithms against real-world artifacts and distribution shifts. We further provide quantitative evidence that our simple-to-use artificial corruptions allow for highly performant, lightweight data augmentation to enhance model robustness. Unlike traditional, generic augmentation strategies, our approach leverages domain knowledge, exhibiting significantly higher robustness when compared to widely adopted methods. By introducing MedMNIST-C and open-sourcing the corresponding library allowing for targeted data augmentations, we contribute to the development of increasingly robust methods tailored to the challenges of medical imaging. The code is available at https://github.com/francescodisalvo05/medmnistc-api .

Medical image registration is a critical task that estimates the spatial correspondence between pairs of images. However, current traditional and deep-learning-based methods rely on similarity measures to generate a deforming field, which often results in disproportionate volume changes in dissimilar regions, especially in tumor regions. These changes can significantly alter the tumor size and underlying anatomy, which limits the practical use of image registration in clinical diagnosis. To address this issue, we have formulated image registration with tumors as a constraint problem that preserves tumor volumes while maximizing image similarity in other normal regions. Our proposed strategy involves a two-stage process. In the first stage, we use similarity-based registration to identify potential tumor regions by their volume change, generating a soft tumor mask accordingly. In the second stage, we propose a volume-preserving registration with a novel adaptive volume-preserving loss that penalizes the change in size adaptively based on the masks calculated from the previous stage. Our approach balances image similarity and volume preservation in different regions, i.e., normal and tumor regions, by using soft tumor masks to adjust the imposition of volume-preserving loss on each one. This ensures that the tumor volume is preserved during the registration process. We have evaluated our strategy on various datasets and network architectures, demonstrating that our method successfully preserves the tumor volume while achieving comparable registration results with state-of-the-art methods. Our codes is available at: https://dddraxxx.github.io/Volume-Preserving-Registration/.

According to the 2021 World Health Organization (WHO) Classification scheme for gliomas, glioma segmentation is a very important basis for diagnosis and genotype prediction. In general, 3D multimodal brain MRI is an effective diagnostic tool. In the past decade, there has been an increase in the use of machine learning, particularly deep learning, for medical images processing. Thanks to the development of foundation models, models pre-trained with large-scale datasets have achieved better results on a variety of tasks. However, for medical images with small dataset sizes, deep learning methods struggle to achieve better results on real-world image datasets. In this paper, we propose a cross-modality attention adapter based on multimodal fusion to fine-tune the foundation model to accomplish the task of glioma segmentation in multimodal MRI brain images with better results. The effectiveness of the proposed method is validated via our private glioma data set from the First Affiliated Hospital of Zhengzhou University (FHZU) in Zhengzhou, China. Our proposed method is superior to current state-of-the-art methods with a Dice of 88.38% and Hausdorff distance of 10.64, thereby exhibiting a 4% increase in Dice to segment the glioma region for glioma treatment.

Medical image retrieval is essential for clinical decision-making and translational research, relying on discriminative visual representations. Yet, current methods remain fragmented, relying on separate architectures and training strategies for 2D, 3D, and video-based medical data. This modality-specific design hampers scalability and inhibits the development of unified representations. To enable unified learning, we curate a large-scale hybrid-modality dataset comprising 867,653 medical imaging samples, including 2D X-rays and ultrasounds, RGB endoscopy videos, and 3D CT scans. Leveraging this dataset, we train M3Ret, a unified visual encoder without any modality-specific customization. It successfully learns transferable representations using both generative (MAE) and contrastive (SimDINO) self-supervised learning (SSL) paradigms. Our approach sets a new state-of-the-art in zero-shot image-to-image retrieval across all individual modalities, surpassing strong baselines such as DINOv3 and the text-supervised BMC-CLIP. More remarkably, strong cross-modal alignment emerges without paired data, and the model generalizes to unseen MRI tasks, despite never observing MRI during pretraining, demonstrating the generalizability of purely visual self-supervision to unseen modalities. Comprehensive analyses further validate the scalability of our framework across model and data sizes. These findings deliver a promising signal to the medical imaging community, positioning M3Ret as a step toward foundation models for visual SSL in multimodal medical image understanding.

Inevitable domain and task discrepancies in real-world scenarios can impair the generalization performance of the pre-trained deep models for medical data. Therefore, we audaciously propose that we should build a general-purpose medical AI system that can be seamlessly adapted to downstream domains/tasks. Since the domain/task adaption procedures usually involve additional labeling work for the target data, designing a data-efficient adaption algorithm is desired to save the cost of transferring the learned knowledge. Our recent work found that vision-language models (VLMs) are efficient learners with extraordinary cross-domain ability. Therefore, in this work, we further explore the possibility of leveraging pre-trained VLMs as medical foundation models for building general-purpose medical AI, where we thoroughly investigate three machine-learning paradigms, i.e., domain/task-specialized learning, joint learning, and continual learning, for training the VLMs and evaluate their generalization performance on cross-domain and cross-task test sets. To alleviate the catastrophic forgetting during sequential training, we employ rehearsal learning and receive a sharp boost in terms of generalization capability. In a nutshell, our empirical evidence suggests that continual learning may be a practical and efficient learning paradigm for the medical foundation model. And we hope researchers can use our empirical evidence as basement to further explore the path toward medical foundation model.

Medical Image Analysis (MedIA) has become an essential tool in medicine and healthcare, aiding in disease diagnosis, prognosis, and treatment planning, and recent successes in deep learning (DL) have made significant contributions to its advances. However, DL models for MedIA remain challenging to deploy in real-world situations, failing for generalization under the distributional gap between training and testing samples, known as a distribution shift problem. Researchers have dedicated their efforts to developing various DL methods to adapt and perform robustly on unknown and out-of-distribution data distributions. This paper comprehensively reviews domain generalization studies specifically tailored for MedIA. We provide a holistic view of how domain generalization techniques interact within the broader MedIA system, going beyond methodologies to consider the operational implications on the entire MedIA workflow. Specifically, we categorize domain generalization methods into data-level, feature-level, model-level, and analysis-level methods. We show how those methods can be used in various stages of the MedIA workflow with DL equipped from data acquisition to model prediction and analysis. Furthermore, we include benchmark datasets and applications used to evaluate these approaches and analyze the strengths and weaknesses of various methods, unveiling future research opportunities.

Image segmentation remains a pivotal component in medical image analysis, aiding in the extraction of critical information for precise diagnostic practices. With the advent of deep learning, automated image segmentation methods have risen to prominence, showcasing exceptional proficiency in processing medical imagery. Motivated by the Segment Anything Model (SAM)-a foundational model renowned for its remarkable precision and robust generalization capabilities in segmenting 2D natural images-we introduce SAM3D, an innovative adaptation tailored for 3D volumetric medical image analysis. Unlike current SAM-based methods that segment volumetric data by converting the volume into separate 2D slices for individual analysis, our SAM3D model processes the entire 3D volume image in a unified approach. Extensive experiments are conducted on multiple medical image datasets to demonstrate that our network attains competitive results compared with other state-of-the-art methods in 3D medical segmentation tasks while being significantly efficient in terms of parameters. Code and checkpoints are available at https://github.com/UARK-AICV/SAM3D.

Purpose: Accurate 3D hand pose estimation supports surgical applications such as skill assessment, robot-assisted interventions, and geometry-aware workflow analysis. However, surgical environments pose severe challenges, including intense and localized lighting, frequent occlusions by instruments or staff, and uniform hand appearance due to gloves, combined with a scarcity of annotated datasets for reliable model training. Method: We propose a robust multi-view pipeline for 3D hand pose estimation in surgical contexts that requires no domain-specific fine-tuning and relies solely on off-the-shelf pretrained models. The pipeline integrates reliable person detection, whole-body pose estimation, and state-of-the-art 2D hand keypoint prediction on tracked hand crops, followed by a constrained 3D optimization. In addition, we introduce a novel surgical benchmark dataset comprising over 68,000 frames and 3,000 manually annotated 2D hand poses with triangulated 3D ground truth, recorded in a replica operating room under varying levels of scene complexity. Results: Quantitative experiments demonstrate that our method consistently outperforms baselines, achieving a 31% reduction in 2D mean joint error and a 76% reduction in 3D mean per-joint position error. Conclusion: Our work establishes a strong baseline for 3D hand pose estimation in surgery, providing both a training-free pipeline and a comprehensive annotated dataset to facilitate future research in surgical computer vision.

While deep networks have achieved broad success in analyzing natural images, when applied to medical scans, they often fail in unexcepted situations. We investigate this challenge and focus on model sensitivity to domain shifts, such as data sampled from different hospitals or data confounded by demographic variables such as sex, race, etc, in the context of chest X-rays and skin lesion images. A key finding we show empirically is that existing visual backbones lack an appropriate prior from the architecture for reliable generalization in these settings. Taking inspiration from medical training, we propose giving deep networks a prior grounded in explicit medical knowledge communicated in natural language. To this end, we introduce Knowledge-enhanced Bottlenecks (KnoBo), a class of concept bottleneck models that incorporates knowledge priors that constrain it to reason with clinically relevant factors found in medical textbooks or PubMed. KnoBo uses retrieval-augmented language models to design an appropriate concept space paired with an automatic training procedure for recognizing the concept. We evaluate different resources of knowledge and recognition architectures on a broad range of domain shifts across 20 datasets. In our comprehensive evaluation with two imaging modalities, KnoBo outperforms fine-tuned models on confounded datasets by 32.4% on average. Finally, evaluations reveal that PubMed is a promising resource for making medical models less sensitive to domain shift, outperforming other resources on both diversity of information and final prediction performance.

Vision foundation models (VFMs) have emerged as powerful tools for surgical scene understanding. However, current approaches predominantly rely on unimodal RGB pre-training, overlooking the complex 3D geometry inherent to surgical environments. Although several architectures support multimodal or geometry-aware inputs in general computer vision, the benefits of incorporating depth information in surgical settings remain underexplored. We conduct a large-scale empirical study comparing eight ViT-based VFMs that differ in pre-training domain, learning objective, and input modality (RGB vs. RGB-D). For pre-training, we use a curated dataset of 1.4 million robotic surgical images paired with depth maps generated from an off-the-shelf network. We evaluate these models under both frozen-backbone and end-to-end fine-tuning protocols across eight surgical datasets spanning object detection, segmentation, depth estimation, and pose estimation. Our experiments yield several consistent findings. Models incorporating explicit geometric tokenization, such as MultiMAE, substantially outperform unimodal baselines across all tasks. Notably, geometric-aware pre-training enables remarkable data efficiency: models fine-tuned on just 25% of labeled data consistently surpass RGB-only models trained on the full dataset. Importantly, these gains require no architectural or runtime changes at inference; depth is used only during pre-training, making adoption straightforward. These findings suggest that multimodal pre-training offers a viable path towards building more capable surgical vision systems.

Multimodal large language models (MLLMs) have shown great potential in general domains but perform poorly in some specific domains due to a lack of domain-specific data, such as image-text data or vedio-text data. In some specific domains, there is abundant graphic and textual data scattered around, but lacks standardized arrangement. In the field of medical ultrasound, there are ultrasonic diagnostic books, ultrasonic clinical guidelines, ultrasonic diagnostic reports, and so on. However, these ultrasonic materials are often saved in the forms of PDF, images, etc., and cannot be directly used for the training of MLLMs. This paper proposes a novel image-text reasoning supervised fine-tuning data generation pipeline to create specific domain quadruplets (image, question, thinking trace, and answer) from domain-specific materials. A medical ultrasound domain dataset ReMUD is established, containing over 45,000 reasoning and non-reasoning supervised fine-tuning Question Answering (QA) and Visual Question Answering (VQA) data. The ReMUD-7B model, fine-tuned on Qwen2.5-VL-7B-Instruct, outperforms general-domain MLLMs in medical ultrasound field. To facilitate research, the ReMUD dataset, data generation codebase, and ReMUD-7B parameters will be released at https://github.com/ShiDaizi/ReMUD, addressing the data shortage issue in specific domain MLLMs.

Recent 3D generative models have achieved remarkable performance in synthesizing high resolution photorealistic images with view consistency and detailed 3D shapes, but training them for diverse domains is challenging since it requires massive training images and their camera distribution information. Text-guided domain adaptation methods have shown impressive performance on converting the 2D generative model on one domain into the models on other domains with different styles by leveraging the CLIP (Contrastive Language-Image Pre-training), rather than collecting massive datasets for those domains. However, one drawback of them is that the sample diversity in the original generative model is not well-preserved in the domain-adapted generative models due to the deterministic nature of the CLIP text encoder. Text-guided domain adaptation will be even more challenging for 3D generative models not only because of catastrophic diversity loss, but also because of inferior text-image correspondence and poor image quality. Here we propose DATID-3D, a domain adaptation method tailored for 3D generative models using text-to-image diffusion models that can synthesize diverse images per text prompt without collecting additional images and camera information for the target domain. Unlike 3D extensions of prior text-guided domain adaptation methods, our novel pipeline was able to fine-tune the state-of-the-art 3D generator of the source domain to synthesize high resolution, multi-view consistent images in text-guided targeted domains without additional data, outperforming the existing text-guided domain adaptation methods in diversity and text-image correspondence. Furthermore, we propose and demonstrate diverse 3D image manipulations such as one-shot instance-selected adaptation and single-view manipulated 3D reconstruction to fully enjoy diversity in text.

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

Recent advances in generative AI have brought incredible breakthroughs in several areas, including medical imaging. These generative models have tremendous potential not only to help safely share medical data via synthetic datasets but also to perform an array of diverse applications, such as anomaly detection, image-to-image translation, denoising, and MRI reconstruction. However, due to the complexity of these models, their implementation and reproducibility can be difficult. This complexity can hinder progress, act as a use barrier, and dissuade the comparison of new methods with existing works. In this study, we present MONAI Generative Models, a freely available open-source platform that allows researchers and developers to easily train, evaluate, and deploy generative models and related applications. Our platform reproduces state-of-art studies in a standardised way involving different architectures (such as diffusion models, autoregressive transformers, and GANs), and provides pre-trained models for the community. We have implemented these models in a generalisable fashion, illustrating that their results can be extended to 2D or 3D scenarios, including medical images with different modalities (like CT, MRI, and X-Ray data) and from different anatomical areas. Finally, we adopt a modular and extensible approach, ensuring long-term maintainability and the extension of current applications for future features.

Accurate segmentation of organs and tumors in CT and MRI scans is essential for diagnosis, treatment planning, and disease monitoring. While deep learning has advanced automated segmentation, most models remain task-specific, lacking generalizability across modalities and institutions. Vision foundation models (FMs) pretrained on billion-scale natural images offer powerful and transferable representations. However, adapting them to medical imaging faces two key challenges: (1) the ViT backbone of most foundation models still underperform specialized CNNs on medical image segmentation, and (2) the large domain gap between natural and medical images limits transferability. We introduce MedDINOv3, a simple and effective framework for adapting DINOv3 to medical segmentation. We first revisit plain ViTs and design a simple and effective architecture with multi-scale token aggregation. Then, we perform domain-adaptive pretraining on CT-3M, a curated collection of 3.87M axial CT slices, using a multi-stage DINOv3 recipe to learn robust dense features. MedDINOv3 matches or exceeds state-of-the-art performance across four segmentation benchmarks, demonstrating the potential of vision foundation models as unified backbones for medical image segmentation. The code is available at https://github.com/ricklisz/MedDINOv3.

Medical image segmentation poses challenges due to domain gaps, data modality variations, and dependency on domain knowledge or experts, especially for low- and middle-income countries (LMICs). Whereas for humans, given a few exemplars (with corresponding labels), we are able to segment different medical images even without exten-sive domain-specific clinical training. In addition, current SAM-based medical segmentation models use fine-grained visual prompts, such as the bounding rectangle generated from manually annotated target segmentation mask, as the bounding box (bbox) prompt during the testing phase. However, in actual clinical scenarios, no such precise prior knowledge is available. Our experimental results also reveal that previous models nearly fail to predict when given coarser bbox prompts. Considering these issues, in this paper, we introduce a domain-aware selective adaptation approach to adapt the general knowledge learned from a large model trained with natural images to the corresponding medical domains/modalities, with access to only a few (e.g. less than 5) exemplars. Our method mitigates the aforementioned limitations, providing an efficient and LMICs-friendly solution. Extensive experimental analysis showcases the effectiveness of our approach, offering potential advancements in healthcare diagnostics and clinical applications in LMICs.

The generation of medical images presents significant challenges due to their high-resolution and three-dimensional nature. Existing methods often yield suboptimal performance in generating high-quality 3D medical images, and there is currently no universal generative framework for medical imaging. In this paper, we introduce the 3D Medical Diffusion (3D MedDiffusion) model for controllable, high-quality 3D medical image generation. 3D MedDiffusion incorporates a novel, highly efficient Patch-Volume Autoencoder that compresses medical images into latent space through patch-wise encoding and recovers back into image space through volume-wise decoding. Additionally, we design a new noise estimator to capture both local details and global structure information during diffusion denoising process. 3D MedDiffusion can generate fine-detailed, high-resolution images (up to 512x512x512) and effectively adapt to various downstream tasks as it is trained on large-scale datasets covering CT and MRI modalities and different anatomical regions (from head to leg). Experimental results demonstrate that 3D MedDiffusion surpasses state-of-the-art methods in generative quality and exhibits strong generalizability across tasks such as sparse-view CT reconstruction, fast MRI reconstruction, and data augmentation.

The rapid advancement of large-scale vision-language models has showcased remarkable capabilities across various tasks. However, the lack of extensive and high-quality image-text data in medicine has greatly hindered the development of large-scale medical vision-language models. In this work, we present a diagnosis-guided bootstrapping strategy that exploits both image and label information to construct vision-language datasets. Based on the constructed dataset, we developed MedDr, a generalist foundation model for healthcare capable of handling diverse medical data modalities, including radiology, pathology, dermatology, retinography, and endoscopy. Moreover, during inference, we propose a simple but effective retrieval-augmented medical diagnosis strategy, which enhances the model's generalization ability. Extensive experiments on visual question answering, medical report generation, and medical image diagnosis demonstrate the superiority of our method.

Medical image analysis is crucial in modern radiological diagnostics, especially given the exponential growth in medical imaging data. The demand for automated report generation systems has become increasingly urgent. While prior research has mainly focused on using machine learning and multimodal language models for 2D medical images, the generation of reports for 3D medical images has been less explored due to data scarcity and computational complexities. This paper introduces 3D-CT-GPT, a Visual Question Answering (VQA)-based medical visual language model specifically designed for generating radiology reports from 3D CT scans, particularly chest CTs. Extensive experiments on both public and private datasets demonstrate that 3D-CT-GPT significantly outperforms existing methods in terms of report accuracy and quality. Although current methods are few, including the partially open-source CT2Rep and the open-source M3D, we ensured fair comparison through appropriate data conversion and evaluation methodologies. Experimental results indicate that 3D-CT-GPT enhances diagnostic accuracy and report coherence, establishing itself as a robust solution for clinical radiology report generation. Future work will focus on expanding the dataset and further optimizing the model to enhance its performance and applicability.

Cross-domain few-shot medical image segmentation (CD-FSMIS) offers a promising and data-efficient solution for medical applications where annotations are severely scarce and multimodal analysis is required. However, existing methods typically filter out domain-specific information to improve generalization, which inadvertently limits cross-domain performance and degrades source-domain accuracy. To address this, we present Contrastive Graph Modeling (C-Graph), a framework that leverages the structural consistency of medical images as a reliable domain-transferable prior. We represent image features as graphs, with pixels as nodes and semantic affinities as edges. A Structural Prior Graph (SPG) layer is proposed to capture and transfer target-category node dependencies and enable global structure modeling through explicit node interactions. Building upon SPG layers, we introduce a Subgraph Matching Decoding (SMD) mechanism that exploits semantic relations among nodes to guide prediction. Furthermore, we design a Confusion-minimizing Node Contrast (CNC) loss to mitigate node ambiguity and subgraph heterogeneity by contrastively enhancing node discriminability in the graph space. Our method significantly outperforms prior CD-FSMIS approaches across multiple cross-domain benchmarks, achieving state-of-the-art performance while simultaneously preserving strong segmentation accuracy on the source domain.

Orthodontic treatment usually requires regular face-to-face examinations to monitor dental conditions of the patients. When in-person diagnosis is not feasible, an alternative is to utilize five intra-oral photographs for remote dental monitoring. However, it lacks of 3D information, and how to reconstruct 3D dental models from such sparse view photographs is a challenging problem. In this study, we propose a 3D teeth reconstruction framework, named TeethDreamer, aiming to restore the shape and position of the upper and lower teeth. Given five intra-oral photographs, our approach first leverages a large diffusion model's prior knowledge to generate novel multi-view images with known poses to address sparse inputs and then reconstructs high-quality 3D teeth models by neural surface reconstruction. To ensure the 3D consistency across generated views, we integrate a 3D-aware feature attention mechanism in the reverse diffusion process. Moreover, a geometry-aware normal loss is incorporated into the teeth reconstruction process to enhance geometry accuracy. Extensive experiments demonstrate the superiority of our method over current state-of-the-arts, giving the potential to monitor orthodontic treatment remotely. Our code is available at https://github.com/ShanghaiTech-IMPACT/TeethDreamer

Despite significant advancements in general artificial intelligence, such as GPT-4, their effectiveness in the medical domain (general medical AI, GMAI) remains constrained due to the absence of specialized medical knowledge. To address this challenge, we present GMAI-VL-5.5M, a comprehensive multimodal medical dataset created by converting hundreds of specialized medical datasets into meticulously constructed image-text pairs. This dataset features comprehensive task coverage, diverse modalities, and high-quality image-text data. Building upon this multimodal dataset, we propose GMAI-VL, a general medical vision-language model with a progressively three-stage training strategy. This approach significantly enhances the model's ability by integrating visual and textual information, thereby improving its ability to process multimodal data and support accurate diagnosis and clinical decision-making. Experimental evaluations demonstrate that GMAI-VL achieves state-of-the-art results across a wide range of multimodal medical tasks, such as visual question answering and medical image diagnosis. Our contributions include the development of the GMAI-VL-5.5M dataset, the introduction of the GMAI-VL model, and the establishment of new benchmarks in multiple medical domains. Code and dataset will be released at https://github.com/uni-medical/GMAI-VL.

Recent advances in video generation have shown remarkable progress in open-domain settings, yet medical video generation remains largely underexplored. Medical videos are critical for applications such as clinical training, education, and simulation, requiring not only high visual fidelity but also strict medical accuracy. However, current models often produce unrealistic or erroneous content when applied to medical prompts, largely due to the lack of large-scale, high-quality datasets tailored to the medical domain. To address this gap, we introduce MedVideoCap-55K, the first large-scale, diverse, and caption-rich dataset for medical video generation. It comprises over 55,000 curated clips spanning real-world medical scenarios, providing a strong foundation for training generalist medical video generation models. Built upon this dataset, we develop MedGen, which achieves leading performance among open-source models and rivals commercial systems across multiple benchmarks in both visual quality and medical accuracy. We hope our dataset and model can serve as a valuable resource and help catalyze further research in medical video generation. Our code and data is available at https://github.com/FreedomIntelligence/MedGen

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

Deep learning algorithms require extensive data to achieve robust performance. However, data availability is often restricted in the medical domain due to patient privacy concerns. Synthetic data presents a possible solution to these challenges. Recently, image generative models have found increasing use for medical applications but are often designed for singular medical specialties and imaging modalities, thus limiting their broader utility. To address this, we introduce MediSyn: a text-guided, latent diffusion model capable of generating synthetic images from 6 medical specialties and 10 image types. The synthetic images are validated by expert clinicians for alignment with their corresponding text prompts. Furthermore, a direct comparison of the synthetic images against the real images confirms that our model synthesizes novel images and, crucially, may preserve patient privacy. Finally, classifiers trained on a mixture of synthetic and real data achieve similar performance to those trained on twice the amount of real data. Our findings highlight the immense potential for generalist image generative models to accelerate algorithmic research and development in medicine.

Recently, deep convolutional neural networks have achieved great success for medical image segmentation. However, unlike segmentation of natural images, most medical images such as MRI and CT are volumetric data. In order to make full use of volumetric information, 3D CNNs are widely used. However, 3D CNNs suffer from higher inference time and computation cost, which hinders their further clinical applications. Additionally, with the increased number of parameters, the risk of overfitting is higher, especially for medical images where data and annotations are expensive to acquire. To issue this problem, many 2.5D segmentation methods have been proposed to make use of volumetric spatial information with less computation cost. Despite these works lead to improvements on a variety of segmentation tasks, to the best of our knowledge, there has not previously been a large-scale empirical comparison of these methods. In this paper, we aim to present a review of the latest developments of 2.5D methods for volumetric medical image segmentation. Additionally, to compare the performance and effectiveness of these methods, we provide an empirical study of these methods on three representative segmentation tasks involving different modalities and targets. Our experimental results highlight that 3D CNNs may not always be the best choice. Despite all these 2.5D methods can bring performance gains to 2D baseline, not all the methods hold the benefits on different datasets. We hope the results and conclusions of our study will prove useful for the community on exploring and developing efficient volumetric medical image segmentation methods.

Vision-Language Models (VLMs) trained via contrastive learning have achieved notable success in natural image tasks. However, their application in the medical domain remains limited due to the scarcity of openly accessible, large-scale medical image-text datasets. Existing medical VLMs either train on closed-source proprietary or relatively small open-source datasets that do not generalize well. Similarly, most models remain specific to a single or limited number of medical imaging domains, again restricting their applicability to other modalities. To address this gap, we introduce UniMed, a large-scale, open-source multi-modal medical dataset comprising over 5.3 million image-text pairs across six diverse imaging modalities: X-ray, CT, MRI, Ultrasound, Pathology, and Fundus. UniMed is developed using a data-collection framework that leverages Large Language Models (LLMs) to transform modality-specific classification datasets into image-text formats while incorporating existing image-text data from the medical domain, facilitating scalable VLM pretraining. Using UniMed, we trained UniMed-CLIP, a unified VLM for six modalities that significantly outperforms existing generalist VLMs and matches modality-specific medical VLMs, achieving notable gains in zero-shot evaluations. For instance, UniMed-CLIP improves over BiomedCLIP (trained on proprietary data) by an absolute gain of +12.61, averaged over 21 datasets, while using 3x less training data. To facilitate future research, we release UniMed dataset, training codes, and models at https://github.com/mbzuai-oryx/UniMed-CLIP.

The scaling laws and extraordinary performance of large foundation models motivate the development and utilization of such models in biomedicine. However, despite early promising results on some biomedical benchmarks, there are still major challenges that need to be addressed before these models can be used in real-world clinics. Frontier general-domain models such as GPT-4V still have significant performance gaps in multimodal biomedical applications. More importantly, less-acknowledged pragmatic issues, including accessibility, model cost, and tedious manual evaluation make it hard for clinicians to use state-of-the-art large models directly on private patient data. Here, we explore training open-source small multimodal models (SMMs) to bridge competency gaps for unmet clinical needs in radiology. To maximize data efficiency, we adopt a modular approach by incorporating state-of-the-art pre-trained models for image and text modalities, and focusing on training a lightweight adapter to ground each modality to the text embedding space, as exemplified by LLaVA-Med. For training, we assemble a large dataset of over 697 thousand radiology image-text pairs. For evaluation, we propose CheXprompt, a GPT-4-based metric for factuality evaluation, and demonstrate its parity with expert evaluation. For best practice, we conduct a systematic ablation study on various choices in data engineering and multimodal training. The resulting LlaVA-Rad (7B) model attains state-of-the-art results on standard radiology tasks such as report generation and cross-modal retrieval, even outperforming much larger models such as GPT-4V and Med-PaLM M (84B). The inference of LlaVA-Rad is fast and can be performed on a single V100 GPU in private settings, offering a promising state-of-the-art tool for real-world clinical applications.

Existing few-shot medical image segmentation (FSMIS) models fail to address a practical issue in medical imaging: the domain shift caused by different imaging techniques, which limits the applicability to current FSMIS tasks. To overcome this limitation, we focus on the cross-domain few-shot medical image segmentation (CD-FSMIS) task, aiming to develop a generalized model capable of adapting to a broader range of medical image segmentation scenarios with limited labeled data from the novel target domain. Inspired by the characteristics of frequency domain similarity across different domains, we propose a Frequency-aware Matching Network (FAMNet), which includes two key components: a Frequency-aware Matching (FAM) module and a Multi-Spectral Fusion (MSF) module. The FAM module tackles two problems during the meta-learning phase: 1) intra-domain variance caused by the inherent support-query bias, due to the different appearances of organs and lesions, and 2) inter-domain variance caused by different medical imaging techniques. Additionally, we design an MSF module to integrate the different frequency features decoupled by the FAM module, and further mitigate the impact of inter-domain variance on the model's segmentation performance. Combining these two modules, our FAMNet surpasses existing FSMIS models and Cross-domain Few-shot Semantic Segmentation models on three cross-domain datasets, achieving state-of-the-art performance in the CD-FSMIS task.

This paper investigates discrepancies in how neural networks learn from different imaging domains, which are commonly overlooked when adopting computer vision techniques from the domain of natural images to other specialized domains such as medical images. Recent works have found that the generalization error of a trained network typically increases with the intrinsic dimension (d_{data}) of its training set. Yet, the steepness of this relationship varies significantly between medical (radiological) and natural imaging domains, with no existing theoretical explanation. We address this gap in knowledge by establishing and empirically validating a generalization scaling law with respect to d_{data}, and propose that the substantial scaling discrepancy between the two considered domains may be at least partially attributed to the higher intrinsic ``label sharpness'' (K_F) of medical imaging datasets, a metric which we propose. Next, we demonstrate an additional benefit of measuring the label sharpness of a training set: it is negatively correlated with the trained model's adversarial robustness, which notably leads to models for medical images having a substantially higher vulnerability to adversarial attack. Finally, we extend our d_{data} formalism to the related metric of learned representation intrinsic dimension (d_{repr}), derive a generalization scaling law with respect to d_{repr}, and show that d_{data} serves as an upper bound for d_{repr}. Our theoretical results are supported by thorough experiments with six models and eleven natural and medical imaging datasets over a range of training set sizes. Our findings offer insights into the influence of intrinsic dataset properties on generalization, representation learning, and robustness in deep neural networks. Code link: https://github.com/mazurowski-lab/intrinsic-properties

Synthetic data generated by generative models can enhance the performance and capabilities of data-hungry deep learning models in medical imaging. However, there is (1) limited availability of (synthetic) datasets and (2) generative models are complex to train, which hinders their adoption in research and clinical applications. To reduce this entry barrier, we propose medigan, a one-stop shop for pretrained generative models implemented as an open-source framework-agnostic Python library. medigan allows researchers and developers to create, increase, and domain-adapt their training data in just a few lines of code. Guided by design decisions based on gathered end-user requirements, we implement medigan based on modular components for generative model (i) execution, (ii) visualisation, (iii) search & ranking, and (iv) contribution. The library's scalability and design is demonstrated by its growing number of integrated and readily-usable pretrained generative models consisting of 21 models utilising 9 different Generative Adversarial Network architectures trained on 11 datasets from 4 domains, namely, mammography, endoscopy, x-ray, and MRI. Furthermore, 3 applications of medigan are analysed in this work, which include (a) enabling community-wide sharing of restricted data, (b) investigating generative model evaluation metrics, and (c) improving clinical downstream tasks. In (b), extending on common medical image synthesis assessment and reporting standards, we show Fréchet Inception Distance variability based on image normalisation and radiology-specific feature extraction.

Currently, evaluating vision-language models (VLMs) in medical imaging tasks oversimplifies clinical reality by relying on pre-selected 2D images that demand significant manual labor to curate. This setup misses the core challenge of realworld diagnostics: a true clinical agent must actively navigate full 3D volumes across multiple sequences or modalities to gather evidence and ultimately support a final decision. To address this, we propose MEDOPENCLAW, an auditable runtime designed to let VLMs operate dynamically within standard medical tools or viewers (e.g., 3D Slicer). On top of this runtime, we introduce MEDFLOWBENCH, a full-study medical imaging benchmark covering multi-sequence brain MRI and lung CT/PET. It systematically evaluates medical agentic capabilities across viewer-only, tool-use, and open-method tracks. Initial results reveal a critical insight: while state-of-the-art LLMs/VLMs (e.g., Gemini 3.1 Pro and GPT-5.4) can successfully navigate the viewer to solve basic study-level tasks, their performance paradoxically degrades when given access to professional support tools due to a lack of precise spatial grounding. By bridging the gap between static-image perception and interactive clinical workflows, MEDOPENCLAW and MEDFLOWBENCH establish a reproducible foundation for developing auditable, full-study medical imaging agents.

We investigate how both the adaptation of a generic foundation model via transfer learning and the integration of complementary modalities from the operating room (OR) can support surgical data science. To this end, we use V-JEPA as the single-modality foundation of a multimodal model for minimally invasive surgery support. We analyze how the model's downstream performance can benefit (a) from finetuning on unlabeled surgical video data and (b) from providing additional time-resolved data streams from the OR in a multimodal setup. In an in-house dataset of liver surgery videos, we analyze the tasks of predicting hospital length of stay and postoperative complications. In videos of the public HeiCo dataset, we analyze the task of surgical phase recognition. As a baseline, we apply pretrained V-JEPA to all tasks. We then finetune it on unlabeled, held-out videos to investigate its change in performance after domain adaptation. Following the idea of modular decision support networks, we integrate additional data streams from the OR by training a separate encoder to form a shared representation space with V-JEPA's embeddings. Our experiments show that finetuning on domain-specific data increases model performance. On the in-house data, integrating additional time-resolved data likewise benefits the model. On the HeiCo data, accuracy of the pretrained video-only, single-modality baseline setup is on par with the top-performing submissions of the EndoVis2017 challenge, while finetuning on domain-specific data increases accuracy further. Our results thus demonstrate how surgical data science can leverage public, generic foundation models. Likewise, they indicate the potential of domain adaptation and of integrating suitable complementary data streams from the OR. To support further research, we release our code and model weights at https://github.com/DigitalSurgeryLab-Basel/ML-CDS-2025.

In Natural Language Processing (NLP), Machine Reading Comprehension (MRC) is the task of answering a question based on a given context. To handle questions in the medical domain, modern language models such as BioBERT, SciBERT and even ChatGPT are trained on vast amounts of in-domain medical corpora. However, in-domain pre-training is expensive in terms of time and resources. In this paper, we propose a resource-efficient approach for injecting domain knowledge into a model without relying on such domain-specific pre-training. Knowledge graphs are powerful resources for accessing medical information. Building on existing work, we introduce a method using Multi-Layer Perceptrons (MLPs) for aligning and integrating embeddings extracted from medical knowledge graphs with the embedding spaces of pre-trained language models (LMs). The aligned embeddings are fused with open-domain LMs BERT and RoBERTa that are fine-tuned for two MRC tasks, span detection (COVID-QA) and multiple-choice questions (PubMedQA). We compare our method to prior techniques that rely on a vocabulary overlap for embedding alignment and show how our method circumvents this requirement to deliver better performance. On both datasets, our method allows BERT/RoBERTa to either perform on par (occasionally exceeding) with stronger domain-specific models or show improvements in general over prior techniques. With the proposed approach, we signal an alternative method to in-domain pre-training to achieve domain proficiency.

Large Language models have demonstrated excellent domain-specific question-answering capabilities when finetuned with a particular dataset of that specific domain. However, fine-tuning the models requires a significant amount of training time and a considerable amount of hardware. In this work, we propose CARE (Customer Assistance and Response Engine), a lightweight model made by fine-tuning Phi3.5-mini on very minimal hardware and data, designed to handle queries primarily across three domains: telecommunications support, medical support, and banking support. For telecommunications and banking, the chatbot addresses issues and problems faced by customers regularly in the above-mentioned domains. In the medical domain, CARE provides preliminary support by offering basic diagnoses and medical suggestions that a user might take before consulting a healthcare professional. Since CARE is built on Phi3.5-mini, it can be used even on mobile devices, increasing its usability. Our research also shows that CARE performs relatively well on various medical benchmarks, indicating that it can be used to make basic medical suggestions.

We introduce MedGemma 1.5 4B, the latest model in the MedGemma collection. MedGemma 1.5 expands on MedGemma 1 by integrating additional capabilities: high-dimensional medical imaging (CT/MRI volumes and histopathology whole slide images), anatomical localization via bounding boxes, multi-timepoint chest X-ray analysis, and improved medical document understanding (lab reports, electronic health records). We detail the innovations required to enable these modalities within a single architecture, including new training data, long-context 3D volume slicing, and whole-slide pathology sampling. Compared to MedGemma 1 4B, MedGemma 1.5 4B demonstrates significant gains in these new areas, improving 3D MRI condition classification accuracy by 11% and 3D CT condition classification by 3% (absolute improvements). In whole slide pathology imaging, MedGemma 1.5 4B achieves a 47% macro F1 gain. Additionally, it improves anatomical localization with a 35% increase in Intersection over Union on chest X-rays and achieves a 4% macro accuracy for longitudinal (multi-timepoint) chest x-ray analysis. Beyond its improved multimodal performance over MedGemma 1, MedGemma 1.5 improves on text-based clinical knowledge and reasoning, improving by 5% on MedQA accuracy and 22% on EHRQA accuracy. It also achieves an average of 18% macro F1 on 4 different lab report information extraction datasets (EHR Datasets 2, 3, 4, and Mendeley Clinical Laboratory Test Reports). Taken together, MedGemma 1.5 serves as a robust, open resource for the community, designed as an improved foundation on which developers can create the next generation of medical AI systems. Resources and tutorials for building upon MedGemma 1.5 can be found at https://goo.gle/MedGemma.

Domain generalization (DG) is proposed to deal with the issue of domain shift, which occurs when statistical differences exist between source and target domains. However, most current methods do not account for a common realistic scenario where the source and target domains have different classes. To overcome this deficiency, open set domain generalization (OSDG) then emerges as a more practical setting to recognize unseen classes in unseen domains. An intuitive approach is to use multiple one-vs-all classifiers to define decision boundaries for each class and reject the outliers as unknown. However, the significant class imbalance between positive and negative samples often causes the boundaries biased towards positive ones, resulting in misclassification for known samples in the unseen target domain. In this paper, we propose a novel meta-learning-based framework called dualistic MEta-learning with joint DomaIn-Class matching (MEDIC), which considers gradient matching towards inter-domain and inter-class splits simultaneously to find a generalizable boundary balanced for all tasks. Experimental results demonstrate that MEDIC not only outperforms previous methods in open set scenarios, but also maintains competitive close set generalization ability at the same time. Our code is available at https://github.com/zzwdx/MEDIC.

In this work, we address the problem of grounding abnormalities in medical images, where the goal is to localize clinical findings based on textual descriptions. While generalist Vision-Language Models (VLMs) excel in natural grounding tasks, they often struggle in the medical domain due to rare, compositional, and domain-specific terms that are poorly aligned with visual patterns. Specialized medical VLMs address this challenge via large-scale domain pretraining, but at the cost of substantial annotation and computational resources. To overcome these limitations, we propose Knowledge to Sight (K2Sight), a framework that introduces structured semantic supervision by decomposing clinical concepts into interpretable visual attributes, such as shape, density, and anatomical location. These attributes are distilled from domain ontologies and encoded into concise instruction-style prompts, which guide region-text alignment during training. Unlike conventional report-level supervision, our approach explicitly bridges domain knowledge and spatial structure, enabling data-efficient training of compact models. We train compact models with 0.23B and 2B parameters using only 1.5\% of the data required by state-of-the-art medical VLMs. Despite their small size and limited training data, these models achieve performance on par with or better than 7B+ medical VLMs, with up to 9.82\% improvement in mAP_{50}. Code and models: https://lijunrio.github.io/K2Sight/{SOTAPink{https://lijunrio.github.io/K2Sight/}}.

Developing Foundation Models for medical image analysis is essential to overcome the unique challenges of radiological tasks. The first challenges of this kind for 3D brain MRI, SSL3D and FOMO25, were held at MICCAI 2025. Our solution ranked first in tracks of both contests. It relies on a U-Net CNN architecture combined with strategies leveraging anatomical priors and neuroimaging domain knowledge. Notably, our models trained 1-2 orders of magnitude faster and were 10 times smaller than competing transformer-based approaches. Models are available here: https://github.com/jbanusco/BrainFM4Challenges.

Medical images often exhibit distribution shifts due to variations in imaging protocols and scanners across different medical centers. Domain Generalization (DG) methods aim to train models on source domains that can generalize to unseen target domains. Recently, the segment anything model (SAM) has demonstrated strong generalization capabilities due to its prompt-based design, and has gained significant attention in image segmentation tasks. Existing SAM-based approaches attempt to address the need for manual prompts by introducing prompt generators that automatically generate these prompts. However, we argue that auto-generated prompts may not be sufficiently accurate under distribution shifts, potentially leading to incorrect predictions that still require manual verification and correction by clinicians. To address this challenge, we propose a method for 2D medical image segmentation called Self-Correcting SAM (CoSAM). Our approach begins by generating coarse masks using SAM in a prompt-free manner, providing prior prompts for the subsequent stages, and eliminating the need for prompt generators. To automatically refine these coarse masks, we introduce a generalized error decoder that simulates the correction process typically performed by clinicians. Furthermore, we generate diverse prompts as feedback based on the corrected masks, which are used to iteratively refine the predictions within a self-correcting loop, enhancing the generalization performance of our model. Extensive experiments on two medical image segmentation benchmarks across multiple scenarios demonstrate the superiority of CoSAM over state-of-the-art SAM-based methods.

A brain tumour is a mass or cluster of abnormal cells in the brain, which has the possibility of becoming life-threatening because of its ability to invade neighbouring tissues and also form metastases. An accurate diagnosis is essential for successful treatment planning and magnetic resonance imaging is the principal imaging modality for diagnostic of brain tumours and their extent. Deep Learning methods in computer vision applications have shown significant improvement in recent years, most of which can be credited to the fact that a sizeable amount of data is available to train models on, and the improvements in the model architectures yielding better approximations in a supervised setting. Classifying tumours using such deep learning methods has made significant progress with the availability of open datasets with reliable annotations. Typically those methods are either 3D models, which use 3D volumetric MRIs or even 2D models considering each slice separately. However, by treating the slice spatial dimension separately, spatiotemporal models can be employed as spatiospatial models for this task. These models have the capabilities of learning specific spatial and temporal relationship, while reducing computational costs. This paper uses two spatiotemporal models, ResNet (2+1)D and ResNet Mixed Convolution, to classify different types of brain tumours. It was observed that both these models performed superior to the pure 3D convolutional model, ResNet18. Furthermore, it was also observed that pre-training the models on a different, even unrelated dataset before training them for the task of tumour classification improves the performance. Finally, Pre-trained ResNet Mixed Convolution was observed to be the best model in these experiments, achieving a macro F1-score of 0.93 and a test accuracy of 96.98\%, while at the same time being the model with the least computational cost.