Jin Sung Kim

Yujin Oh, Sangjoon Park, Hwa Kyung Byun et al.

Target volume contouring for radiation therapy is considered significantly more challenging than the normal organ segmentation tasks as it necessitates the utilization of both image and text-based clinical information. Inspired by the recent advancement of large language models (LLMs) that can facilitate the integration of the textural information and images, here we present a novel LLM-driven multimodal AI, namely LLMSeg, that utilizes the clinical text information and is applicable to the challenging task of target volume contouring for radiation therapy, and validate it within the context of breast cancer radiation therapy target volume contouring. Using external validation and data-insufficient environments, which attributes highly conducive to real-world applications, we demonstrate that the proposed model exhibits markedly improved performance compared to conventional unimodal AI models, particularly exhibiting robust generalization performance and data efficiency. To our best knowledge, this is the first LLM-driven multimodal AI model that integrates the clinical text information into target volume delineation for radiation oncology.

Yujin Oh, Sangjoon Park, Xiang Li et al.

Clinical decision-making reflects diverse strategies shaped by regional patient populations and institutional protocols. However, most existing medical artificial intelligence (AI) models are trained on highly prevalent data patterns, which reinforces biases and fails to capture the breadth of clinical expertise. Inspired by the recent advances in Mixture of Experts (MoE), we propose a Mixture of Multicenter Experts (MoME) framework to address AI bias in the medical domain without requiring data sharing across institutions. MoME integrates specialized expertise from diverse clinical strategies to enhance model generalizability and adaptability across medical centers. We validate this framework using a multimodal target volume delineation model for prostate cancer radiotherapy. With few-shot training that combines imaging and clinical notes from each center, the model outperformed baselines, particularly in settings with high inter-center variability or limited data availability. Furthermore, MoME enables model customization to local clinical preferences without cross-institutional data exchange, making it especially suitable for resource-constrained settings while promoting broadly generalizable medical AI.

Yoon Jo Kim, Wonyoung Cho, Jongmin Lee et al.

Delineating the clinical target volume (CTV) in radiotherapy involves complex margins constrained by tumor location and anatomical barriers. While deep learning models automate this process, their rigid reliance on expert-annotated data requires costly retraining whenever clinical guidelines update. To overcome this limitation, we introduce OncoAgent, a novel guideline-aware AI agent framework that seamlessly converts textual clinical guidelines into three-dimensional target contours in a training-free manner. Evaluated on esophageal cancer cases, the agent achieves a zero-shot Dice similarity coefficient of 0.842 for the CTV and 0.880 for the planning target volume, demonstrating performance highly comparable to a fully supervised nnU-Net baseline. Notably, in a blinded clinical evaluation, physicians strongly preferred OncoAgent over the supervised baseline, rating it higher in guideline compliance, modification effort, and clinical acceptability. Furthermore, the framework generalizes zero-shot to alternative esophageal guidelines and other anatomical sites (e.g., prostate) without any retraining. Beyond mere volumetric overlap, our agent-based paradigm offers near-instantaneous adaptability to alternative guidelines, providing a scalable and transparent pathway toward interpretability in radiotherapy treatment planning.

Muhammad Imran, Jonathan R. Krebs, Vishal Balaji Sivaraman et al.

Multi-class segmentation of the aorta in computed tomography angiography (CTA) scans is essential for diagnosing and planning complex endovascular treatments for patients with aortic dissections. However, existing methods reduce aortic segmentation to a binary problem, limiting their ability to measure diameters across different branches and zones. Furthermore, no open-source dataset is currently available to support the development of multi-class aortic segmentation methods. To address this gap, we organized the AortaSeg24 MICCAI Challenge, introducing the first dataset of 100 CTA volumes annotated for 23 clinically relevant aortic branches and zones. This dataset was designed to facilitate both model development and validation. The challenge attracted 121 teams worldwide, with participants leveraging state-of-the-art frameworks such as nnU-Net and exploring novel techniques, including cascaded models, data augmentation strategies, and custom loss functions. We evaluated the submitted algorithms using the Dice Similarity Coefficient (DSC) and Normalized Surface Distance (NSD), highlighting the approaches adopted by the top five performing teams. This paper presents the challenge design, dataset details, evaluation metrics, and an in-depth analysis of the top-performing algorithms. The annotated dataset, evaluation code, and implementations of the leading methods are publicly available to support further research. All resources can be accessed at https://aortaseg24.grand-challenge.org.

Kyung Ho Lim, Ujin Kang, Xiang Li et al.

Large language models (LLMs) are increasingly used in healthcare, but their reliability is heavily influenced by user-driven factors such as question phrasing and the completeness of clinical information. In this study, we examined how misinformation framing, source authority, model persona, and omission of key clinical details affect the diagnostic accuracy and reliability of LLM outputs. We conducted two experiments: one introducing misleading external opinions with varying assertiveness (perturbation test), and another removing specific categories of patient information (ablation test). Using public datasets (MedQA and Medbullets), we evaluated proprietary models (GPT-4o, Claude 3.5 Sonnet, Claude 3.5 Haiku, Gemini 1.5 Pro, Gemini 1.5 Flash) and open-source models (LLaMA 3 8B, LLaMA 3 Med42 8B, DeepSeek R1 8B). All models were vulnerable to user-driven misinformation, with proprietary models especially affected by definitive and authoritative language. Assertive tone had the greatest negative impact on accuracy. In the ablation test, omitting physical exam findings and lab results caused the most significant performance drop. Although proprietary models had higher baseline accuracy, their performance declined sharply under misinformation. These results highlight the need for well-structured prompts and complete clinical context. Users should avoid authoritative framing of misinformation and provide full clinical details, especially for complex cases.

Yujin Oh, Pengfei Jin, Sangjoon Park et al.

Ensuring fairness in medical image segmentation is critical due to biases in imbalanced clinical data acquisition caused by demographic attributes (e.g., age, sex, race) and clinical factors (e.g., disease severity). To address these challenges, we introduce Distribution-aware Mixture of Experts (dMoE), inspired by optimal control theory. We provide a comprehensive analysis of its underlying mechanisms and clarify dMoE's role in adapting to heterogeneous distributions in medical image segmentation. Furthermore, we integrate dMoE into multiple network architectures, demonstrating its broad applicability across diverse medical image analysis tasks. By incorporating demographic and clinical factors, dMoE achieves state-of-the-art performance on two 2D benchmark datasets and a 3D in-house dataset. Our results highlight the effectiveness of dMoE in mitigating biases from imbalanced distributions, offering a promising approach to bridging control theory and medical image segmentation within fairness learning paradigms. The source code will be made available. The source code is available at https://github.com/tvseg/dMoE.

Joonil Hwang, Sangjoon Park, NaHyeon Park et al.

In radiation therapy (RT), the reliance on pre-treatment computed tomography (CT) images encounter challenges due to anatomical changes, necessitating adaptive planning. Daily cone-beam CT (CBCT) imaging, pivotal for therapy adjustment, falls short in tissue density accuracy. To address this, our innovative approach integrates diffusion models for CT image generation, offering precise control over data synthesis. Leveraging a self-training method with knowledge distillation, we maximize CBCT data during therapy, complemented by sparse paired fan-beam CTs. This strategy, incorporated into state-of-the-art diffusion-based models, surpasses conventional methods like Pix2pix and CycleGAN. A meticulously curated dataset of 2800 paired CBCT and CT scans, supplemented by 4200 CBCT scans, undergoes preprocessing and teacher model training, including the Brownian Bridge Diffusion Model (BBDM). Pseudo-label CT images are generated, resulting in a dataset combining 5600 CT images with corresponding CBCT images. Thorough evaluation using MSE, SSIM, PSNR and LPIPS demonstrates superior performance against Pix2pix and CycleGAN. Our approach shows promise in generating high-quality CT images from CBCT scans in RT.

Kwanyoung Kim, Yujin Oh, Sangjoon Park et al.

Recent advances in AI foundation models have significant potential for lightening the clinical workload by mimicking the comprehensive and multi-faceted approaches used by medical professionals. In the field of radiation oncology, the integration of multiple modalities holds great importance, so the opportunity of foundational model is abundant. Inspired by this, here we present RO-LMM, a multi-purpose, comprehensive large multimodal model (LMM) tailored for the field of radiation oncology. This model effectively manages a series of tasks within the clinical workflow, including clinical context summarization, radiation treatment plan suggestion, and plan-guided target volume segmentation by leveraging the capabilities of LMM. In particular, to perform consecutive clinical tasks without error accumulation, we present a novel Consistency Embedding Fine-Tuning (CEFTune) technique, which boosts LMM's robustness to noisy inputs while preserving the consistency of handling clean inputs. We further extend this concept to LMM-driven segmentation framework, leading to a novel Consistency Embedding Segmentation (CESEG) techniques. Experimental results including multi-centre validation confirm that our RO-LMM with CEFTune and CESEG results in promising performance for multiple clinical tasks with generalization capabilities.

Jaehee Chun, Justin C. Park, Sven Olberg et al.

In this study, we propose a tailored DL framework for patient-specific performance that leverages the behavior of a model intentionally overfitted to a patient-specific training dataset augmented from the prior information available in an ART workflow - an approach we term Intentional Deep Overfit Learning (IDOL). Implementing the IDOL framework in any task in radiotherapy consists of two training stages: 1) training a generalized model with a diverse training dataset of N patients, just as in the conventional DL approach, and 2) intentionally overfitting this general model to a small training dataset-specific the patient of interest (N+1) generated through perturbations and augmentations of the available task- and patient-specific prior information to establish a personalized IDOL model. The IDOL framework itself is task-agnostic and is thus widely applicable to many components of the ART workflow, three of which we use as a proof of concept here: the auto-contouring task on re-planning CTs for traditional ART, the MRI super-resolution (SR) task for MRI-guided ART, and the synthetic CT (sCT) reconstruction task for MRI-only ART. In the re-planning CT auto-contouring task, the accuracy measured by the Dice similarity coefficient improves from 0.847 with the general model to 0.935 by adopting the IDOL model. In the case of MRI SR, the mean absolute error (MAE) is improved by 40% using the IDOL framework over the conventional model. Finally, in the sCT reconstruction task, the MAE is reduced from 68 to 22 HU by utilizing the IDOL framework.