LesionLocator: Zero-Shot Universal Tumor Segmentation and Tracking in 3D Whole-Body Imaging

In this work, we present LesionLocator, a framework for zero-shot longitudinal lesion tracking and segmentation in 3D medical imaging, establishing the first end-to-end model capable of 4D tracking with dense spatial prompts. Our model leverages an extensive dataset of 23,262 annotated medical scans, as well as synthesized longitudinal data across diverse lesion types. The diversity and scale of our dataset significantly enhances model generalizability to real-world medical imaging challenges and addresses key limitations in longitudinal data availability. LesionLocator outperforms all existing promptable models in lesion segmentation by nearly 10 dice points, reaching human-level performance, and achieves state-of-the-art results in lesion tracking, with superior lesion retrieval and segmentation accuracy. LesionLocator not only sets a new benchmark in universal promptable lesion segmentation and automated longitudinal lesion tracking but also provides the first open-access solution of its kind, releasing our synthetic 4D dataset and model to the community, empowering future advancements in medical imaging. Code is available at: www.github.com/MIC-DKFZ/LesionLocator

Explainable, Multi-modal Wound Infection Classification from Images Augmented with Generated Captions

Infections in Diabetic Foot Ulcers (DFUs) can cause severe complications, including tissue death and limb amputation, highlighting the need for accurate, timely diagnosis. Previous machine learning methods have focused on identifying infections by analyzing wound images alone, without utilizing additional metadata such as medical notes. In this study, we aim to improve infection detection by introducing Synthetic Caption Augmented Retrieval for Wound Infection Detection (SCARWID), a novel deep learning framework that leverages synthetic textual descriptions to augment DFU images. SCARWID consists of two components: (1) Wound-BLIP, a Vision-Language Model (VLM) fine-tuned on GPT-4o-generated descriptions to synthesize consistent captions from images; and (2) an Image-Text Fusion module that uses cross-attention to extract cross-modal embeddings from an image and its corresponding Wound-BLIP caption. Infection status is determined by retrieving the top-k similar items from a labeled support set. To enhance the diversity of training data, we utilized a latent diffusion model to generate additional wound images. As a result, SCARWID outperformed state-of-the-art models, achieving average sensitivity, specificity, and accuracy of 0.85, 0.78, and 0.81, respectively, for wound infection classification. Displaying the generated captions alongside the wound images and infection detection results enhances interpretability and trust, enabling nurses to align SCARWID outputs with their medical knowledge. This is particularly valuable when wound notes are unavailable or when assisting novice nurses who may find it difficult to identify visual attributes of wound infection.

Progressive Local Alignment for Medical Multimodal Pre-training

Local alignment between medical images and text is essential for accurate diagnosis, though it remains challenging due to the absence of natural local pairings and the limitations of rigid region recognition methods. Traditional approaches rely on hard boundaries, which introduce uncertainty, whereas medical imaging demands flexible soft region recognition to handle irregular structures. To overcome these challenges, we propose the Progressive Local Alignment Network (PLAN), which designs a novel contrastive learning-based approach for local alignment to establish meaningful word-pixel relationships and introduces a progressive learning strategy to iteratively refine these relationships, enhancing alignment precision and robustness. By combining these techniques, PLAN effectively improves soft region recognition while suppressing noise interference. Extensive experiments on multiple medical datasets demonstrate that PLAN surpasses state-of-the-art methods in phrase grounding, image-text retrieval, object detection, and zero-shot classification, setting a new benchmark for medical image-text alignment.

Reducing Hallucinations of Medical Multimodal Large Language Models with Visual Retrieval-Augmented Generation

Multimodal Large Language Models (MLLMs) have shown impressive performance in vision and text tasks. However, hallucination remains a major challenge, especially in fields like healthcare where details are critical. In this work, we show how MLLMs may be enhanced to support Visual RAG (V-RAG), a retrieval-augmented generation framework that incorporates both text and visual data from retrieved images. On the MIMIC-CXR chest X-ray report generation and Multicare medical image caption generation datasets, we show that Visual RAG improves the accuracy of entity probing, which asks whether a medical entities is grounded by an image. We show that the improvements extend both to frequent and rare entities, the latter of which may have less positive training data. Downstream, we apply V-RAG with entity probing to correct hallucinations and generate more clinically accurate X-ray reports, obtaining a higher RadGraph-F1 score.

DCFormer: Efficient 3D Vision-Language Modeling with Decomposed Convolutions

Vision-language models (VLMs) align visual and textual representations, enabling high-performance zero-shot classification and image-text retrieval in 2D medical imaging. However, extending VLMs to 3D medical imaging remains computationally challenging. Existing 3D VLMs rely on Vision Transformers (ViTs), which are computationally expensive due to self-attention's quadratic complexity, or 3D convolutions, which demand excessive parameters and FLOPs as kernel size increases. We introduce DCFormer, an efficient 3D medical image encoder that factorizes 3D convolutions into three parallel 1D convolutions along depth, height, and width. This design preserves spatial information while significantly reducing computational cost. Integrated into a CLIP-based vision-language framework, DCFormer is evaluated on CT-RATE, a dataset of 50,188 paired 3D chest CT volumes and radiology reports, for zero-shot multi-abnormality detection across 18 pathologies. Compared to ViT, ConvNeXt, PoolFormer, and TransUNet, DCFormer achieves superior efficiency and accuracy, with DCFormer-Tiny reaching 62.0% accuracy and a 46.3% F1-score while using significantly fewer parameters. These results highlight DCFormer's potential for scalable, clinically deployable 3D medical VLMs. Our codes will be publicly available.

VisTA: Vision-Text Alignment Model with Contrastive Learning using Multimodal Data for Evidence-Driven, Reliable, and Explainable Alzheimer's Disease Diagnosis

Objective: Assessing Alzheimer's disease (AD) using high-dimensional radiology images is clinically important but challenging. Although Artificial Intelligence (AI) has advanced AD diagnosis, it remains unclear how to design AI models embracing predictability and explainability. Here, we propose VisTA, a multimodal language-vision model assisted by contrastive learning, to optimize disease prediction and evidence-based, interpretable explanations for clinical decision-making. Methods: We developed VisTA (Vision-Text Alignment Model) for AD diagnosis. Architecturally, we built VisTA from BiomedCLIP and fine-tuned it using contrastive learning to align images with verified abnormalities and their descriptions. To train VisTA, we used a constructed reference dataset containing images, abnormality types, and descriptions verified by medical experts. VisTA produces four outputs: predicted abnormality type, similarity to reference cases, evidence-driven explanation, and final AD diagnoses. To illustrate VisTA's efficacy, we reported accuracy metrics for abnormality retrieval and dementia prediction. To demonstrate VisTA's explainability, we compared its explanations with human experts' explanations. Results: Compared to 15 million images used for baseline pretraining, VisTA only used 170 samples for fine-tuning and obtained significant improvement in abnormality retrieval and dementia prediction. For abnormality retrieval, VisTA reached 74% accuracy and an AUC of 0.87 (26% and 0.74, respectively, from baseline models). For dementia prediction, VisTA achieved 88% accuracy and an AUC of 0.82 (30% and 0.57, respectively, from baseline models). The generated explanations agreed strongly with human experts' and provided insights into the diagnostic process. Taken together, VisTA optimize prediction, clinical reasoning, and explanation.

ConceptVAE: Self-Supervised Fine-Grained Concept Disentanglement from 2D Echocardiographies

While traditional self-supervised learning methods improve performance and robustness across various medical tasks, they rely on single-vector embeddings that may not capture fine-grained concepts such as anatomical structures or organs. The ability to identify such concepts and their characteristics without supervision has the potential to improve pre-training methods, and enable novel applications such as fine-grained image retrieval and concept-based outlier detection. In this paper, we introduce ConceptVAE, a novel pre-training framework that detects and disentangles fine-grained concepts from their style characteristics in a self-supervised manner. We present a suite of loss terms and model architecture primitives designed to discretise input data into a preset number of concepts along with their local style. We validate ConceptVAE both qualitatively and quantitatively, demonstrating its ability to detect fine-grained anatomical structures such as blood pools and septum walls from 2D cardiac echocardiographies. Quantitatively, ConceptVAE outperforms traditional self-supervised methods in tasks such as region-based instance retrieval, semantic segmentation, out-of-distribution detection, and object detection. Additionally, we explore the generation of in-distribution synthetic data that maintains the same concepts as the training data but with distinct styles, highlighting its potential for more calibrated data generation. Overall, our study introduces and validates a promising new pre-training technique based on concept-style disentanglement, opening multiple avenues for developing models for medical image analysis that are more interpretable and explainable than black-box approaches.

Polyp-Gen: Realistic and Diverse Polyp Image Generation for Endoscopic Dataset Expansion

Automated diagnostic systems (ADS) have shown significant potential in the early detection of polyps during endoscopic examinations, thereby reducing the incidence of colorectal cancer. However, due to high annotation costs and strict privacy concerns, acquiring high-quality endoscopic images poses a considerable challenge in the development of ADS. Despite recent advancements in generating synthetic images for dataset expansion, existing endoscopic image generation algorithms failed to accurately generate the details of polyp boundary regions and typically required medical priors to specify plausible locations and shapes of polyps, which limited the realism and diversity of the generated images. To address these limitations, we present Polyp-Gen, the first full-automatic diffusion-based endoscopic image generation framework. Specifically, we devise a spatial-aware diffusion training scheme with a lesion-guided loss to enhance the structural context of polyp boundary regions. Moreover, to capture medical priors for the localization of potential polyp areas, we introduce a hierarchical retrieval-based sampling strategy to match similar fine-grained spatial features. In this way, our Polyp-Gen can generate realistic and diverse endoscopic images for building reliable ADS. Extensive experiments demonstrate the state-of-the-art generation quality, and the synthetic images can improve the downstream polyp detection task. Additionally, our Polyp-Gen has shown remarkable zero-shot generalizability on other datasets. The source code is available at https://github.com/CUHK-AIM-Group/Polyp-Gen.

Benchmarking Robustness of Contrastive Learning Models for Medical Image-Report Retrieval

Medical images and reports offer invaluable insights into patient health. The heterogeneity and complexity of these data hinder effective analysis. To bridge this gap, we investigate contrastive learning models for cross-domain retrieval, which associates medical images with their corresponding clinical reports. This study benchmarks the robustness of four state-of-the-art contrastive learning models: CLIP, CXR-RePaiR, MedCLIP, and CXR-CLIP. We introduce an occlusion retrieval task to evaluate model performance under varying levels of image corruption. Our findings reveal that all evaluated models are highly sensitive to out-of-distribution data, as evidenced by the proportional decrease in performance with increasing occlusion levels. While MedCLIP exhibits slightly more robustness, its overall performance remains significantly behind CXR-CLIP and CXR-RePaiR. CLIP, trained on a general-purpose dataset, struggles with medical image-report retrieval, highlighting the importance of domain-specific training data. The evaluation of this work suggests that more effort needs to be spent on improving the robustness of these models. By addressing these limitations, we can develop more reliable cross-domain retrieval models for medical applications.

Vision Foundation Models for Computed Tomography

Foundation models (FMs) have shown transformative potential in radiology by performing diverse, complex tasks across imaging modalities. Here, we developed CT-FM, a large-scale 3D image-based pre-trained model designed explicitly for various radiological tasks. CT-FM was pre-trained using 148,000 computed tomography (CT) scans from the Imaging Data Commons through label-agnostic contrastive learning. We evaluated CT-FM across four categories of tasks, namely, whole-body and tumor segmentation, head CT triage, medical image retrieval, and semantic understanding, showing superior performance against state-of-the-art models. Beyond quantitative success, CT-FM demonstrated the ability to cluster regions anatomically and identify similar anatomical and structural concepts across scans. Furthermore, it remained robust across test-retest settings and indicated reasonable salient regions attached to its embeddings. This study demonstrates the value of large-scale medical imaging foundation models and by open-sourcing the model weights, code, and data, aims to support more adaptable, reliable, and interpretable AI solutions in radiology.