Dimitrios Bounias

Stefan Denner, Markus Bujotzek, Dimitrios Bounias et al.

Medical image classification plays a crucial role in clinical decision-making, yet most models are constrained to a fixed set of predefined classes, limiting their adaptability to new conditions. Contrastive Language-Image Pretraining (CLIP) offers a promising solution by enabling zero-shot classification through multimodal large-scale pretraining. However, while CLIP effectively captures global image content, radiology requires a more localized focus on specific pathology regions to enhance both interpretability and diagnostic accuracy. To address this, we explore the potential of incorporating visual cues into zero-shot classification, embedding visual markers, such as arrows, bounding boxes, and circles, directly into radiological images to guide model attention. Evaluating across four public chest X-ray datasets, we demonstrate that visual markers improve AUROC by up to 0.185, highlighting their effectiveness in enhancing classification performance. Furthermore, attention map analysis confirms that visual cues help models focus on clinically relevant areas, leading to more interpretable predictions.To support further research, we use public datasets and provide our codebase and preprocessing pipeline under https://github.com/MIC-DKFZ/VPE-in-Radiology, serving as a reference point for future work on localized classification in medical imaging.

Balint Kovacs, Nils Netzer, Michael Baumgartner et al.

Data augmentation (DA) is a key factor in medical image analysis, such as in prostate cancer (PCa) detection on magnetic resonance images. State-of-the-art computer-aided diagnosis systems still rely on simplistic spatial transformations to preserve the pathological label post transformation. However, such augmentations do not substantially increase the organ as well as tumor shape variability in the training set, limiting the model's ability to generalize to unseen cases with more diverse localized soft-tissue deformations. We propose a new anatomy-informed transformation that leverages information from adjacent organs to simulate typical physiological deformations of the prostate and generates unique lesion shapes without altering their label. Due to its lightweight computational requirements, it can be easily integrated into common DA frameworks. We demonstrate the effectiveness of our augmentation on a dataset of 774 biopsy-confirmed examinations, by evaluating a state-of-the-art method for PCa detection with different augmentation settings.

Stefan Denner, Jonas Scherer, Klaus Kades et al.

In the rapidly evolving field of medical imaging, machine learning algorithms have become indispensable for enhancing diagnostic accuracy. However, the effectiveness of these algorithms is contingent upon the availability and organization of high-quality medical imaging datasets. Traditional Digital Imaging and Communications in Medicine (DICOM) data management systems are inadequate for handling the scale and complexity of data required to be facilitated in machine learning algorithms. This paper introduces an innovative data curation tool, developed as part of the Kaapana open-source toolkit, aimed at streamlining the organization, management, and processing of large-scale medical imaging datasets. The tool is specifically tailored to meet the needs of radiologists and machine learning researchers. It incorporates advanced search, auto-annotation and efficient tagging functionalities for improved data curation. Additionally, the tool facilitates quality control and review, enabling researchers to validate image and segmentation quality in large datasets. It also plays a critical role in uncovering potential biases in datasets by aggregating and visualizing metadata, which is essential for developing robust machine learning models. Furthermore, Kaapana is integrated within the Radiological Cooperative Network (RACOON), a pioneering initiative aimed at creating a comprehensive national infrastructure for the aggregation, transmission, and consolidation of radiological data across all university clinics throughout Germany. A supplementary video showcasing the tool's functionalities can be accessed at https://bit.ly/MICCAI-DEMI2023.

Lidia Garrucho, Smriti Joshi, Kaisar Kushibar et al.

Breast cancer is the most frequently diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality. Dynamic contrast-enhanced magnetic resonance imaging plays a central role in tumor characterization and treatment monitoring, particularly in patients receiving neoadjuvant chemotherapy. However, existing artificial intelligence models for breast magnetic resonance imaging are often developed using single-center data and evaluated using aggregate performance metrics, limiting their generalizability and obscuring potential performance disparities across demographic subgroups. The MAMA-MIA Challenge was designed to address these limitations by introducing a large-scale benchmark that jointly evaluates primary tumor segmentation and prediction of pathologic complete response using pre-treatment magnetic resonance imaging only. The training cohort comprised 1,506 patients from multiple institutions in the United States, while evaluation was conducted on an external test set of 574 patients from three independent European centers to assess cross-continental and cross-institutional generalization. A unified scoring framework combined predictive performance with subgroup consistency across age, menopausal status, and breast density. Twenty-six international teams participated in the final evaluation phase. Results demonstrate substantial performance variability under external testing and reveal trade-offs between overall accuracy and subgroup fairness. The challenge provides standardized datasets, evaluation protocols, and public resources to promote the development of robust and equitable artificial intelligence systems for breast cancer imaging.

Stefan Denner, David Zimmerer, Dimitrios Bounias et al.

Content-based image retrieval (CBIR) has the potential to significantly improve diagnostic aid and medical research in radiology. However, current CBIR systems face limitations due to their specialization to certain pathologies, limiting their utility. On the other hand, several vision foundation models have been shown to produce general-purpose visual features. Therefore, in this work, we propose using vision foundation models as powerful and versatile off-the-shelf feature extractors for content-based image retrieval. Our contributions include: (1) benchmarking a diverse set of vision foundation models on an extensive dataset comprising 1.6 million 2D radiological images across four modalities and 161 pathologies; (2) identifying weakly-supervised models, particularly BiomedCLIP, as highly effective, achieving a achieving a P@1 of up to 0.594 (P@3: 0.590, P@5: 0.588, P@10: 0.583), comparable to specialized CBIR systems but without additional training; (3) conducting an in-depth analysis of the impact of index size on retrieval performance; (4) evaluating the quality of embedding spaces generated by different models; and (5) investigating specific challenges associated with retrieving anatomical versus pathological structures. Despite these challenges, our research underscores the vast potential of foundation models for CBIR in radiology, proposing a shift towards versatile, general-purpose medical image retrieval systems that do not require specific tuning. Our code, dataset splits and embeddings are publicly available under https://github.com/MIC-DKFZ/foundation-models-for-cbmir.

Katharina Eckstein, Constantin Ulrich, Michael Baumgartner et al.

Large-scale pre-training holds the promise to advance 3D medical object detection, a crucial component of accurate computer-aided diagnosis. Yet, it remains underexplored compared to segmentation, where pre-training has already demonstrated significant benefits. Existing pre-training approaches for 3D object detection rely on 2D medical data or natural image pre-training, failing to fully leverage 3D volumetric information. In this work, we present the first systematic study of how existing pre-training methods can be integrated into state-of-the-art detection architectures, covering both CNNs and Transformers. Our results show that pre-training consistently improves detection performance across various tasks and datasets. Notably, reconstruction-based self-supervised pre-training outperforms supervised pre-training, while contrastive pre-training provides no clear benefit for 3D medical object detection. Our code is publicly available at: https://github.com/MIC-DKFZ/nnDetection-finetuning.

Santhosh Parampottupadam, Melih Coşğun, Sarthak Pati et al.

Federated Learning (FL) offers a promising approach for training clinical AI models without centralizing sensitive patient data. However, its real-world adoption is hindered by challenges related to privacy, resource constraints, and compliance. Existing Differential Privacy (DP) approaches often apply uniform noise, which disproportionately degrades model performance, even among well-compliant institutions. In this work, we propose a novel compliance-aware FL framework that enhances DP by adaptively adjusting noise based on quantifiable client compliance scores. Additionally, we introduce a compliance scoring tool based on key healthcare and security standards to promote secure, inclusive, and equitable participation across diverse clinical settings. Extensive experiments on public datasets demonstrate that integrating under-resourced, less compliant clinics with highly regulated institutions yields accuracy improvements of up to 15% over traditional FL. This work advances FL by balancing privacy, compliance, and performance, making it a viable solution for real-world clinical workflows in global healthcare.