Wenqi Lu

Xi Jia, Alexander Thorley, Alberto Gomez et al.

U-Net style networks are commonly utilized in unsupervised image registration to predict dense displacement fields, which for high-resolution volumetric image data is a resource-intensive and time-consuming task. To tackle this challenge, we first propose Fourier-Net, which replaces the costly U-Net style expansive path with a parameter-free model-driven decoder. Instead of directly predicting a full-resolution displacement field, our Fourier-Net learns a low-dimensional representation of the displacement field in the band-limited Fourier domain which our model-driven decoder converts to a full-resolution displacement field in the spatial domain. Expanding upon Fourier-Net, we then introduce Fourier-Net+, which additionally takes the band-limited spatial representation of the images as input and further reduces the number of convolutional layers in the U-Net style network's contracting path. Finally, to enhance the registration performance, we propose a cascaded version of Fourier-Net+. We evaluate our proposed methods on three datasets, on which our proposed Fourier-Net and its variants achieve comparable results with current state-of-the art methods, while exhibiting faster inference speeds, lower memory footprint, and fewer multiply-add operations. With such small computational cost, our Fourier-Net+ enables the efficient training of large-scale 3D registration on low-VRAM GPUs. Our code is publicly available at \url{https://github.com/xi-jia/Fourier-Net}.

Xi Jia, Joseph Bartlett, Tianyang Zhang et al.

Due to their extreme long-range modeling capability, vision transformer-based networks have become increasingly popular in deformable image registration. We believe, however, that the receptive field of a 5-layer convolutional U-Net is sufficient to capture accurate deformations without needing long-range dependencies. The purpose of this study is therefore to investigate whether U-Net-based methods are outdated compared to modern transformer-based approaches when applied to medical image registration. For this, we propose a large kernel U-Net (LKU-Net) by embedding a parallel convolutional block to a vanilla U-Net in order to enhance the effective receptive field. On the public 3D IXI brain dataset for atlas-based registration, we show that the performance of the vanilla U-Net is already comparable with that of state-of-the-art transformer-based networks (such as TransMorph), and that the proposed LKU-Net outperforms TransMorph by using only 1.12% of its parameters and 10.8% of its mult-adds operations. We further evaluate LKU-Net on a MICCAI Learn2Reg 2021 challenge dataset for inter-subject registration, our LKU-Net also outperforms TransMorph on this dataset and ranks first on the public leaderboard as of the submission of this work. With only modest modifications to the vanilla U-Net, we show that U-Net can outperform transformer-based architectures on inter-subject and atlas-based 3D medical image registration. Code is available at https://github.com/xi-jia/LKU-Net.

Nurjahan Sultana, Moi Hoon Yap, Xinqi Fan et al.

Models for AI-based skin cancer screening suffer a severe performance drop when shifting from expert dermoscopic (source) images to consumer-grade clinical (target) images, hindering real-world deployment. Existing domain adaptation methods often ignore crucial semantic invariants, such as clinical concepts. While new foundation models like MONET can provide this semantic information as dense, probabilistic scores, this metadata is unavailable at test time, creating a deployment paradox for practical image-only screening tools. We address this gap by proposing CoFiDA-M, a privileged information framework that learns from concepts at training time but deploys as an image-only model. Our method trains a teacher network that uses MONET concept probabilities to guide a FiLM modulator, transforming visual features into a semantically ``edited" feature space. A lightweight, image-only student is then trained to reproduce this edited representation, not just the teacher's final predictions. This distillation ``bakes" the clinical reasoning into the student's weights. On a challenging multi-dataset benchmark, our image-only student significantly outperforms state-of-the-art approaches, especially in melanoma recall. Our work provides a practical and generalizable framework for leveraging noisy, probabilistic metadata as privileged information, demonstrating strong cross-dataset robustness and potential for real-world deployment beyond dermatology. Implementation code is available at: https://github.com/mmu-dermatology-research/CoFiDA.git

Xi Jia, Joseph Bartlett, Wei Chen et al.

Unsupervised image registration commonly adopts U-Net style networks to predict dense displacement fields in the full-resolution spatial domain. For high-resolution volumetric image data, this process is however resource-intensive and time-consuming. To tackle this problem, we propose the Fourier-Net, replacing the expansive path in a U-Net style network with a parameter-free model-driven decoder. Specifically, instead of our Fourier-Net learning to output a full-resolution displacement field in the spatial domain, we learn its low-dimensional representation in a band-limited Fourier domain. This representation is then decoded by our devised model-driven decoder (consisting of a zero padding layer and an inverse discrete Fourier transform layer) to the dense, full-resolution displacement field in the spatial domain. These changes allow our unsupervised Fourier-Net to contain fewer parameters and computational operations, resulting in faster inference speeds. Fourier-Net is then evaluated on two public 3D brain datasets against various state-of-the-art approaches. For example, when compared to a recent transformer-based method, named TransMorph, our Fourier-Net, which only uses 2.2\% of its parameters and 6.66\% of the multiply-add operations, achieves a 0.5\% higher Dice score and an 11.48 times faster inference speed. Code is available at \url{https://github.com/xi-jia/Fourier-Net}.

Xinxing Cheng, Xi Jia, Wenqi Lu et al.

Deep image registration has demonstrated exceptional accuracy and fast inference. Recent advances have adopted either multiple cascades or pyramid architectures to estimate dense deformation fields in a coarse-to-fine manner. However, due to the cascaded nature and repeated composition/warping operations on feature maps, these methods negatively increase memory usage during training and testing. Moreover, such approaches lack explicit constraints on the learning process of small deformations at different scales, thus lacking explainability. In this study, we introduce a model-driven WiNet that incrementally estimates scale-wise wavelet coefficients for the displacement/velocity field across various scales, utilizing the wavelet coefficients derived from the original input image pair. By exploiting the properties of the wavelet transform, these estimated coefficients facilitate the seamless reconstruction of a full-resolution displacement/velocity field via our devised inverse discrete wavelet transform (IDWT) layer. This approach avoids the complexities of cascading networks or composition operations, making our WiNet an explainable and efficient competitor with other coarse-to-fine methods. Extensive experimental results from two 3D datasets show that our WiNet is accurate and GPU efficient. The code is available at https://github.com/x-xc/WiNet .

Sakib Ahammed, Xia Cui, Xinqi Fan et al.

Modern vision models increasingly rely on rich semantic representations that extend beyond class labels to include descriptive concepts and contextual attributes. However, existing datasets exhibit Semantic Coverage Imbalance (SCI), a previously overlooked bias arising from the long-tailed semantic representations. Unlike class imbalance, SCI occurs at the semantic level, affecting how models learn and reason about rare yet meaningful semantics. To mitigate SCI, we propose Semantic Coverage-Aware Network (SemCovNet), a novel model that explicitly learns to correct semantic coverage disparities. SemCovNet integrates a Semantic Descriptor Map (SDM) for learning semantic representations, a Descriptor Attention Modulation (DAM) module that dynamically weights visual and concept features, and a Descriptor-Visual Alignment (DVA) loss that aligns visual features with descriptor semantics. We quantify semantic fairness using a Coverage Disparity Index (CDI), which measures the alignment between coverage and error. Extensive experiments across multiple datasets demonstrate that SemCovNet enhances model reliability and substantially reduces CDI, achieving fairer and more equitable performance. This work establishes SCI as a measurable and correctable bias, providing a foundation for advancing semantic fairness and interpretable vision learning.

Yuting Zhang, Boyang Liu, Karina V. Bunting et al.

The echocardiographic measurement of left ventricular ejection fraction (LVEF) is fundamental to the diagnosis and classification of patients with heart failure (HF). In order to quantify LVEF automatically and accurately, this paper proposes a new pipeline method based on deep neural networks and ensemble learning. Within the pipeline, an Atrous Convolutional Neural Network (ACNN) was first trained to segment the left ventricle (LV), before employing the area-length formulation based on the ellipsoid single-plane model to calculate LVEF values. This formulation required inputs of LV area, derived from segmentation using an improved Jeffrey's method, as well as LV length, derived from a novel ensemble learning model. To further improve the pipeline's accuracy, an automated peak detection algorithm was used to identify end-diastolic and end-systolic frames, avoiding issues with human error. Subsequently, single-beat LVEF values were averaged across all cardiac cycles to obtain the final LVEF. This method was developed and internally validated in an open-source dataset containing 10,030 echocardiograms. The Pearson's correlation coefficient was 0.83 for LVEF prediction compared to expert human analysis (p<0.001), with a subsequent area under the receiver operator curve (AUROC) of 0.98 (95% confidence interval 0.97 to 0.99) for categorisation of HF with reduced ejection (HFrEF; LVEF<40%). In an external dataset with 200 echocardiograms, this method achieved an AUC of 0.90 (95% confidence interval 0.88 to 0.91) for HFrEF assessment. This study demonstrates that an automated neural network-based calculation of LVEF is comparable to expert clinicians performing time-consuming, frame-by-frame manual evaluation of cardiac systolic function.

Xi Jia, Wenqi Lu, Xinxing Cheng et al.

In unsupervised medical image registration, the predominant approaches involve the utilization of a encoder-decoder network architecture, allowing for precise prediction of dense, full-resolution displacement fields from given paired images. Despite its widespread use in the literature, we argue for the necessity of making both the encoder and decoder learnable in such an architecture. For this, we propose a novel network architecture, termed LessNet in this paper, which contains only a learnable decoder, while entirely omitting the utilization of a learnable encoder. LessNet substitutes the learnable encoder with simple, handcrafted features, eliminating the need to learn (optimize) network parameters in the encoder altogether. Consequently, this leads to a compact, efficient, and decoder-only architecture for 3D medical image registration. Evaluated on two publicly available brain MRI datasets, we demonstrate that our decoder-only LessNet can effectively and efficiently learn both dense displacement and diffeomorphic deformation fields in 3D. Furthermore, our decoder-only LessNet can achieve comparable registration performance to state-of-the-art methods such as VoxelMorph and TransMorph, while requiring significantly fewer computational resources. Our code and pre-trained models are available at https://github.com/xi-jia/LessNet.

Xinxing Cheng, Tianyang Zhang, Wenqi Lu et al.

Deep learning-based image registration methods have shown state-of-the-art performance and rapid inference speeds. Despite these advances, many existing approaches fall short in capturing spatially varying information in non-local regions of feature maps due to the reliance on spatially-shared convolution kernels. This limitation leads to suboptimal estimation of deformation fields. In this paper, we propose a 3D Spatial-Awareness Convolution Block (SACB) to enhance the spatial information within feature representations. Our SACB estimates the spatial clusters within feature maps by leveraging feature similarity and subsequently parameterizes the adaptive convolution kernels across diverse regions. This adaptive mechanism generates the convolution kernels (weights and biases) tailored to spatial variations, thereby enabling the network to effectively capture spatially varying information. Building on SACB, we introduce a pyramid flow estimator (named SACB-Net) that integrates SACBs to facilitate multi-scale flow composition, particularly addressing large deformations. Experimental results on the brain IXI and LPBA datasets as well as Abdomen CT datasets demonstrate the effectiveness of SACB and the superiority of SACB-Net over the state-of-the-art learning-based registration methods. The code is available at https://github.com/x-xc/SACB_Net .

Wenqi Lu, Michael Toss, Emad Rakha et al.

Human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive factor which is overexpressed in 15-20% of breast cancer (BCa). The determination of its status is a key clinical decision making step for selection of treatment regimen and prognostication. HER2 status is evaluated using transcroptomics or immunohistochemistry (IHC) through situ hybridisation (ISH) which require additional costs and tissue burden in addition to analytical variabilities in terms of manual observational biases in scoring. In this study, we propose a novel graph neural network (GNN) based model (termed SlideGraph+) to predict HER2 status directly from whole-slide images of routine Haematoxylin and Eosin (H&E) slides. The network was trained and tested on slides from The Cancer Genome Atlas (TCGA) in addition to two independent test datasets. We demonstrate that the proposed model outperforms the state-of-the-art methods with area under the ROC curve (AUC) values > 0.75 on TCGA and 0.8 on independent test sets. Our experiments show that the proposed approach can be utilised for case triaging as well as pre-ordering diagnostic tests in a diagnostic setting. It can also be used for other weakly supervised prediction problems in computational pathology. The SlideGraph+ code is available at https://github.com/wenqi006/SlideGraph.

Jintao Song, Wenqi Lu, Yunwen Lei et al.

The Alternating Direction Method of Multipliers (ADMM) has gained significant attention across a broad spectrum of machine learning applications. Incorporating the over-relaxation technique shows potential for enhancing the convergence rate of ADMM. However, determining optimal algorithmic parameters, including both the associated penalty and relaxation parameters, often relies on empirical approaches tailored to specific problem domains and contextual scenarios. Incorrect parameter selection can significantly hinder ADMM's convergence rate. To address this challenge, in this paper we first propose a general approach to optimize the value of penalty parameter, followed by a novel closed-form formula to compute the optimal relaxation parameter in the context of linear quadratic problems (LQPs). We then experimentally validate our parameter selection methods through random instantiations and diverse imaging applications, encompassing diffeomorphic image registration, image deblurring, and MRI reconstruction.

Yuting Zhang, Karina V. Bunting, Asgher Champsi et al.

Cardiovascular diseases (CVDs) remain the foremost cause of mortality worldwide, a burden worsened by a severe deficit of healthcare workers. Artificial intelligence (AI) agents have shown potential to alleviate this gap via automated early detection and proactive screening, yet their clinical application remains limited by: 1) prompt-based clinical role assignment that relies on intrinsic model capabilities without domain-specific tool support; or 2) rigid sequential workflows, whereas clinical care often requires adaptive reasoning that orders specific tests and, based on their results, guides personalised next steps; 3) general and static knowledge bases without continuous learning capability; and 4) fixed unimodal or bimodal inputs and lack of on-demand visual outputs when further clarification is needed. In response, a multimodal framework, CardAIc-Agents, was proposed to augment models with external tools and adaptively support diverse cardiac tasks. Specifically, a CardiacRAG agent generated general plans from updatable cardiac knowledge, while the chief agent integrated tools to autonomously execute these plans and deliver decisions. To enable adaptive and case-specific customization, a stepwise update strategy was proposed to dynamically refine plans based on preceding execution results, once the task was assessed as complex. In addition, a multidisciplinary discussion tool was introduced to interpret challenging cases, thereby supporting further adaptation. When clinicians raised concerns, visual review panels were provided to assist final validation. Experiments across three datasets showed the efficiency of CardAIc-Agents compared to mainstream Vision-Language Models (VLMs), state-of-the-art agentic systems, and fine-tuned VLMs.

Yuting Zhang, Tiantian Geng, Luoying Hao et al.

Contemporary cardiovascular management involves complex consideration and integration of multimodal cardiac datasets, where each modality provides distinct but complementary physiological characteristics. While the effective integration of multiple modalities could yield a holistic clinical profile that accurately models the true clinical situation with respect to data modalities and their relatives weightings, current methodologies remain limited by: 1) the scarcity of patient- and time-aligned multimodal data; 2) reliance on isolated single-modality or rigid multimodal input combinations; 3) alignment strategies that prioritize cross-modal similarity over complementarity; and 4) a narrow single-task focus. In response to these limitations, a comprehensive multimodal dataset was curated for immediate application, integrating laboratory test results, electrocardiograms, and echocardiograms with clinical outcomes. Subsequently, a unified framework, Textual Guidance Multimodal fusion for Multiple cardiac tasks (TGMM), was proposed. TGMM incorporated three key components: 1) a MedFlexFusion module designed to capture the unique and complementary characteristics of medical modalities and dynamically integrate data from diverse cardiac sources and their combinations; 2) a textual guidance module to derive task-relevant representations tailored to diverse clinical objectives, including heart disease diagnosis, risk stratification and information retrieval; and 3) a response module to produce final decisions for all these tasks. Furthermore, this study systematically explored key features across multiple modalities and elucidated their synergistic contributions in clinical decision-making. Extensive experiments showed that TGMM outperformed state-of-the-art methods across multiple clinical tasks, with additional validation confirming its robustness on another public dataset.

Ziwei Zou, Bei Zou, Xiaoyan Kui et al.

Atlas construction is fundamental to medical image analysis, offering a standardized spatial reference for tasks such as population-level anatomical modeling. While data-driven registration methods have recently shown promise in pairwise settings, their reliance on large training datasets, limited generalizability, and lack of true inference phases in groupwise contexts hinder their practical use. In contrast, model-driven methods offer training-free, theoretically grounded, and data-efficient alternatives, though they often face scalability and optimization challenges when applied to large 3D datasets. In this work, we introduce DARC (Diffeomorphic Atlas Registration via Coordinate descent), a novel model-driven groupwise registration framework for atlas construction. DARC supports a broad range of image dissimilarity metrics and efficiently handles arbitrary numbers of 3D images without incurring GPU memory issues. Through a coordinate descent strategy and a centrality-enforcing activation function, DARC produces unbiased, diffeomorphic atlases with high anatomical fidelity. Beyond atlas construction, we demonstrate two key applications: (1) One-shot segmentation, where labels annotated only on the atlas are propagated to subjects via inverse deformations, outperforming state-of-the-art few-shot methods; and (2) shape synthesis, where new anatomical variants are generated by warping the atlas mesh using synthesized diffeomorphic deformation fields. Overall, DARC offers a flexible, generalizable, and resource-efficient framework for atlas construction and applications.

Noorul Wahab, Islam M Miligy, Katherine Dodd et al.

Recent advances in whole slide imaging (WSI) technology have led to the development of a myriad of computer vision and artificial intelligence (AI) based diagnostic, prognostic, and predictive algorithms. Computational Pathology (CPath) offers an integrated solution to utilize information embedded in pathology WSIs beyond what we obtain through visual assessment. For automated analysis of WSIs and validation of machine learning (ML) models, annotations at the slide, tissue and cellular levels are required. The annotation of important visual constructs in pathology images is an important component of CPath projects. Improper annotations can result in algorithms which are hard to interpret and can potentially produce inaccurate and inconsistent results. Despite the crucial role of annotations in CPath projects, there are no well-defined guidelines or best practices on how annotations should be carried out. In this paper, we address this shortcoming by presenting the experience and best practices acquired during the execution of a large-scale annotation exercise involving a multidisciplinary team of pathologists, ML experts and researchers as part of the Pathology image data Lake for Analytics, Knowledge and Education (PathLAKE) consortium. We present a real-world case study along with examples of different types of annotations, diagnostic algorithm, annotation data dictionary and annotation constructs. The analyses reported in this work highlight best practice recommendations that can be used as annotation guidelines over the lifecycle of a CPath project.

Wenqi Lu, Jinming Duan, Joshua Deepak Veesa et al.

The forward model in diffuse optical tomography (DOT) describes how light propagates through a turbid medium. It is often approximated by a diffusion equation (DE) that is numerically discretized by the classical finite element method (FEM). We propose a nonlocal diffusion equation (NDE) as a new forward model for DOT, the discretization of which is carried out with an efficient graph-based numerical method (GNM). To quantitatively evaluate the new forward model, we first conduct experiments on a homogeneous slab, where the numerical accuracy of both NDE and DE is compared against the existing analytical solution. We further evaluate NDE by comparing its image reconstruction performance (inverse problem) to that of DE. Our experiments show that NDE is quantitatively comparable to DE and is up to 64% faster due to the efficient graph-based representation that can be implemented identically for geometries in different dimensions.

Wenqi Lu, Jinming Duan, David Orive-Miguel et al.

Total variation (TV) is a powerful regularization method that has been widely applied in different imaging applications, but is difficult to apply to diffuse optical tomography (DOT) image reconstruction (inverse problem) due to complex and unstructured geometries, non-linearity of the data fitting and regularization terms, and non-differentiability of the regularization term. We develop several approaches to overcome these difficulties by: i) defining discrete differential operators for unstructured geometries using both finite element and graph representations; ii) developing an optimization algorithm based on the alternating direction method of multipliers (ADMM) for the non-differentiable and non-linear minimization problem; iii) investigating isotropic and anisotropic variants of TV regularization, and comparing their finite element- and graph-based implementations. These approaches are evaluated on experiments on simulated data and real data acquired from a tissue phantom. Our results show that both FEM and graph-based TV regularization is able to accurately reconstruct both sparse and non-sparse distributions without the over-smoothing effect of Tikhonov regularization and the over-sparsifying effect of L$_1$ regularization. The graph representation was found to out-perform the FEM method for low-resolution meshes, and the FEM method was found to be more accurate for high-resolution meshes.