João Renato Ribeiro Manesco

Pedro Henrique Paiola, Gabriel Lino Garcia, João Renato Ribeiro Manesco et al.

This study evaluates the performance of large language models (LLMs) as medical agents in Portuguese, aiming to develop a reliable and relevant virtual assistant for healthcare professionals. The HealthCareMagic-100k-en and MedQuAD datasets, translated from English using GPT-3.5, were used to fine-tune the ChatBode-7B model using the PEFT-QLoRA method. The InternLM2 model, with initial training on medical data, presented the best overall performance, with high precision and adequacy in metrics such as accuracy, completeness and safety. However, DrBode models, derived from ChatBode, exhibited a phenomenon of catastrophic forgetting of acquired medical knowledge. Despite this, these models performed frequently or even better in aspects such as grammaticality and coherence. A significant challenge was low inter-rater agreement, highlighting the need for more robust assessment protocols. This work paves the way for future research, such as evaluating multilingual models specific to the medical field, improving the quality of training data, and developing more consistent evaluation methodologies for the medical field.

Yasmin Rodrigues Sobrinho, João Renato Ribeiro Manesco, João Paulo Papa

The integration of quantum machine learning with classical deep learning offers promising avenues for medical image analysis by mapping data into high-dimensional Hilbert spaces. However, effectively unifying these distinct paradigms remains challenging due to common optimization asymmetries. In this paper, a novel hybrid quantum-classical architecture for breast cancer diagnosis based on a dual-branch feature-extraction pipeline is proposed. Our framework extracts and unifies complementary representations from classical models and quantum circuits, exploring both trainable and deterministic (non-trainable) quantum paradigms. To integrate these embeddings, three progressive feature fusion strategies are introduced: Static Hybrid Fusion (SHF) for offline extraction, Dynamic Hybrid Fusion (DHF) for end-to-end co-adaptation, and a novel Temperature-Scaled Hybrid Fusion (TSHF). The TSHF strategy incorporates a learnable scalar, inspired by multimodal learning, that dynamically balances hybrid gradient dynamics and resolves optimization bottlenecks. Empirical validation on the BreastMNIST dataset confirms our hypothesis that unifying diverse feature representations creates a richer data context. The TSHF strategy, specifically when pairing a ResNet backbone with a trainable quantum circuit, achieved a peak accuracy of 87.82%, F1-score of 91.77%, and an AUC-ROC of 89.08%, outperforming purely classical baselines. These results demonstrate that the proposed hybrid framework improves classification accuracy and threshold reliability, providing a stable, high-performance architecture for the clinical deployment of quantum-enhanced diagnostic tools.

Gabriel Lino Garcia, João Renato Ribeiro Manesco, Pedro Henrique Paiola et al.

The rapid advancement of large language models (LLMs) has opened new boundaries in the extraction and synthesis of medical knowledge, particularly within evidence synthesis. This paper reviews the state-of-the-art applications of LLMs in the biomedical domain, exploring their effectiveness in automating complex tasks such as evidence synthesis and data extraction from a biomedical corpus of documents. While LLMs demonstrate remarkable potential, significant challenges remain, including issues related to hallucinations, contextual understanding, and the ability to generalize across diverse medical tasks. We highlight critical gaps in the current research literature, particularly the need for unified benchmarks to standardize evaluations and ensure reliability in real-world applications. In addition, we propose directions for future research, emphasizing the integration of state-of-the-art techniques such as retrieval-augmented generation (RAG) to enhance LLM performance in evidence synthesis. By addressing these challenges and utilizing the strengths of LLMs, we aim to improve access to medical literature and facilitate meaningful discoveries in healthcare.

Tobias Rueckert, David Rauber, Raphaela Maerkl et al.

Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding.