Peiyuan Jing

Chun-Wun Cheng, Yanqi Cheng, Peiyuan Jing et al.

Medical image segmentation commonly relies on U-shaped encoder-decoder architectures such as U-Net, where skip connections preserve fine spatial detail by injecting high-resolution encoder features into the decoder. However, these skip pathways also propagate low-level textures, background clutter, and acquisition noise, allowing irrelevant information to bypass deeper semantic filtering -- an issue that is particularly detrimental in low-contrast clinical imaging. Although attention gates have been introduced to address this limitation, they typically produce dense sigmoid masks that softly reweight features rather than explicitly removing irrelevant activations. We propose ProSMA-UNet (Proximal-Sparse Multi-Scale Attention U-Net), which reformulates skip gating as a decoder-conditioned sparse feature selection problem. ProSMA constructs a multi-scale compatibility field using lightweight depthwise dilated convolutions to capture relevance across local and contextual scales, then enforces explicit sparsity via an $\ell_1$ proximal operator with learnable per-channel thresholds, yielding a closed-form soft-thresholding gate that can remove noisy responses. To further suppress semantically irrelevant channels, ProSMA incorporates decoder-conditioned channel gating driven by global decoder context. Extensive experiments on challenging 2D and 3D benchmarks demonstrate state-of-the-art performance, with particularly large gains ($\approx20$\%) on difficult 3D segmentation tasks. Project page: https://math-ml-x.github.io/ProSMA-UNet/

Kinhei Lee, Peiyuan Jing, Zhenxuan Zhang et al.

Large scale vision language models have shown promise in automating chest Xray interpretation, yet their clinical utility remains limited by a gap between model outputs and radiologist reasoning. Most systems optimize for semantic information without emulating how experts visually examine medical images, often overlooking critical findings or diverging from established diagnostic workflows. Radiologists follow structured protocols (e.g., the ABCDEF approach) that ensure all clinically relevant regions are systematically examined, reducing missed findings and supporting reliable diagnostic reasoning. We introduce GazeX, a vision language model that leverages radiologists' eye tracking data as a behavioral prior to model expert diagnostic reasoning. By incorporating gaze trajectories and fixation patterns into pretraining, GazeX learns to follow the spatial and temporal structure of radiologist attention and integrates observations in a clinically meaningful sequence. Using a curated dataset of over 30,000 gaze key frames from five radiologists, we demonstrate that GazeX produces more accurate, interpretable, and expert consistent outputs across radiology report generation, disease grounding, and visual question answering, utilizing 231,835 radiographic studies, 780,014 question answer pairs, and 1,162 image sentence pairs with bounding boxes. Unlike autonomous reporting systems, GazeX produces verifiable evidence artifacts, including inspection trajectories and finding linked localized regions, enabling efficient human verification and safe human AI collaboration. Learning through expert eyes provides a practical route toward more trustworthy, explainable, and diagnostically robust AI systems for radiology and beyond.

Liutao Yang, Zi Wang, Peiyuan Jing et al.

PET super-resolution is highly under-constrained because paired multi-resolution scans from the same subject are rarely available, and effective resolution is determined by scanner-specific physics (e.g., PSF, detector geometry, and acquisition settings). This limits supervised end-to-end training and makes purely image-domain generative restoration prone to hallucinated structures when anatomical and physical constraints are weak. We formulate PET super-resolution as posterior inference under heterogeneous system configurations and propose a CT-conditioned diffusion framework with physics-constrained sampling. During training, a conditional diffusion prior is learned from high-quality PET/CT pairs using cross-attention for anatomical guidance, without requiring paired LR--HR PET data. During inference, measurement consistency is enforced through a scanner-aware forward model with explicit PSF effects and gradient-based data-consistency refinement. Under both standard and OOD settings, the proposed method consistently improves experimental metrics and lesion-level clinical relevance indicators over strong baselines, while reducing hallucination artifacts and improving structural fidelity.

Zhenxuan Zhang, Peiyuan Jing, Ruicheng Yuan et al.

Low-field to high-field MRI synthesis has emerged as a cost-effective strategy to enhance image quality under hardware and acquisition constraints, particularly in scenarios where access to high-field scanners is limited or impractical. Despite recent progress in diffusion models, diffusion-based approaches often struggle to balance fine-detail recovery and structural fidelity. In particular, the uncontrolled generation of high-resolution details in structurally ambiguous regions may introduce anatomically inconsistent patterns, such as spurious edges or artificial texture variations. These artifacts can bias downstream quantitative analysis. For example, they may cause inaccurate tissue boundary delineation or erroneous volumetric estimation, ultimately reducing clinical trust in synthesized images. These limitations highlight the need for generative models that are not only visually accurate but also spatially reliable and anatomically consistent. To address this issue, we propose a reliability-aware diffusion framework (ReDiff) that improves synthesis robustness at both the sampling and post-generation stages. Specifically, we introduce a reliability-guided sampling strategy to suppress unreliable responses during the denoising process. We further develop an uncertainty-aware multi-candidate selection scheme to enhance the reliability of the final prediction. Experiments on multi-center MRI datasets demonstrate improved structural fidelity and reduced artifacts compared with state-of-the-art methods.

Peiyuan Jing, Chun-Wun Cheng, Liutao Yang et al.

Low-dose Positron Emission Tomography (PET) reduces radiation exposure but suffers from severe noise and quantitative degradation. Diffusion-based denoising models achieve strong final reconstructions, yet their reverse trajectories are typically unconstrained and not aligned with the progressive nature of PET dose formation. We propose MAP-Diff, a multi-anchor guided diffusion framework for progressive 3D whole-body PET denoising. MAP-Diff introduces clinically observed intermediate-dose scans as trajectory anchors and enforces timestep-dependent supervision to regularize the reverse process toward dose-aligned intermediate states. Anchor timesteps are calibrated via degradation matching between simulated diffusion corruption and real multi-dose PET pairs, and a timestep-weighted anchor loss stabilizes stage-wise learning. At inference, the model requires only ultra-low-dose input while enabling progressive, dose-consistent intermediate restoration. Experiments on internal (Siemens Biograph Vision Quadra) and cross-scanner (United Imaging uEXPLORER) datasets show consistent improvements over strong CNN-, Transformer-, GAN-, and diffusion-based baselines. On the internal dataset, MAP-Diff improves PSNR from 42.48 dB to 43.71 dB (+1.23 dB), increases SSIM to 0.986, and reduces NMAE from 0.115 to 0.103 (-0.012) compared to 3D DDPM. Performance gains generalize across scanners, achieving 34.42 dB PSNR and 0.141 NMAE on the external cohort, outperforming all competing methods.

Zhenxuan Zhang, Kinhei Lee, Peiyuan Jing et al.

Automatic medical report generation has the potential to support clinical diagnosis, reduce the workload of radiologists, and demonstrate potential for enhancing diagnostic consistency. However, current evaluation metrics often fail to reflect the clinical reliability of generated reports. Early overlap-based methods focus on textual matches between predicted and ground-truth entities but miss fine-grained clinical details (e.g., anatomical location, severity). Some diagnostic metrics are limited by fixed vocabularies or templates, reducing their ability to capture diverse clinical expressions. LLM-based approaches further lack interpretable reasoning steps, making it hard to assess or trust their behavior in safety-critical settings. These limitations hinder the comprehensive assessment of the reliability of generated reports and pose risks in their selection for clinical use. Therefore, we propose a Granular Explainable Multi-Agent Score (GEMA-Score) in this paper, which conducts both objective quantification and subjective evaluation through a large language model-based multi-agent workflow. Our GEMA-Score parses structured reports and employs stable calculations through interactive exchanges of information among agents to assess disease diagnosis, location, severity, and uncertainty. Additionally, an LLM-based scoring agent evaluates completeness, readability, and clinical terminology while providing explanatory feedback. Extensive experiments validate that GEMA-Score achieves the highest correlation with human expert evaluations on a public dataset, demonstrating its effectiveness in clinical scoring (Kendall coefficient = $0.69$ for ReXVal dataset and Kendall coefficient = $0.45$ for RadEvalX dataset). The anonymous project demo is available at: https://github.com/Zhenxuan-Zhang/GEMA_score.

Zhenxuan Zhang, Peiyuan Jing, Coraline Beitone et al.

Given the scarcity and cost of high-field MRI, the synthesis of high-field MRI from low-field MRI holds significant potential when there is limited data for training downstream tasks (e.g. segmentation). Low-field MRI often suffers from a reduced signal-to-noise ratio (SNR) and spatial resolution compared to high-field MRI. However, synthesizing high-field MRI data presents challenges. These involve aligning image features across domains while preserving anatomical accuracy and enhancing fine details. To address these challenges, we propose a Pretext Task Adversarial (PTA) learning framework for high-field MRI synthesis from low-field MRI data. The framework comprises three processes: (1) The slice-wise gap perception (SGP) network aligns the slice inconsistencies of low-field and high-field datasets based on contrastive learning. (2) The local structure correction (LSC) network extracts local structures by restoring the locally rotated and masked images. (3) The pretext task-guided adversarial training process introduces additional supervision and incorporates a discriminator to improve image realism. Extensive experiments on low-field to ultra high-field task demonstrate the effectiveness of our method, achieving state-of-the-art performance (16.892 in FID, 1.933 in IS, and 0.324 in MS-SSIM). This enables the generation of high-quality high-field-like MRI data from low-field MRI data to augment training datasets for downstream tasks. The code is available at: https://github.com/Zhenxuan-Zhang/PTA4Unpaired_HF_MRI_SYN.

Zhonghao Zhan, Huichi Zhou, Zhenhao Li et al.

Tool-integrated agents are deployed on the premise that external tools ground their outputs in reality. Yet this very reliance creates a critical attack surface. Current evaluations benchmark capability in benign settings, asking "can the agent use tools correctly" but never "what if the tools lie". We identify this Trust Gap: agents are evaluated for performance, not for skepticism. We formalize this vulnerability as Adversarial Environmental Injection (AEI), a threat model where adversaries compromise tool outputs to deceive agents. AEI constitutes environmental deception: constructing a "fake world" of poisoned search results and fabricated reference networks around unsuspecting agents. We operationalize this via POTEMKIN, a Model Context Protocol (MCP)-compatible harness for plug-and-play robustness testing. We identify two orthogonal attack surfaces: The Illusion (breadth attacks) poison retrieval to induce epistemic drift toward false beliefs, while The Maze (depth attacks) exploit structural traps to cause policy collapse into infinite loops. Across 11,000+ runs on five frontier agents, we find a stark robustness gap: resistance to one attack often increases vulnerability to the other, demonstrating that epistemic and navigational robustness are distinct capabilities.

Peiyuan Jing, Kinhei Lee, Zhenxuan Zhang et al.

Radiology report generation is critical for efficiency but current models lack the structured reasoning of experts, hindering clinical trust and explainability by failing to link visual findings to precise anatomical locations. This paper introduces BoxMed-RL, a groundbreaking unified training framework for generating spatially verifiable and explainable radiology reports. Built on a large vision-language model, BoxMed-RL revolutionizes report generation through two integrated phases: (1) In the Pretraining Phase, we refine the model via medical concept learning, using Chain-of-Thought supervision to internalize the radiologist-like workflow, followed by spatially verifiable reinforcement, which applies reinforcement learning to align medical findings with bounding boxes. (2) In the Downstream Adapter Phase, we freeze the pretrained weights and train a downstream adapter to ensure fluent and clinically credible reports. This framework precisely mimics radiologists' workflow, compelling the model to connect high-level medical concepts with definitive anatomical evidence. Extensive experiments on public datasets demonstrate that BoxMed-RL achieves an average 7% improvement in both METEOR and ROUGE-L metrics compared to state-of-the-art methods. An average 5% improvement in large language model-based metrics further underscores BoxMed-RL's robustness in generating high-quality radiology reports.

Congren Dai, Yue Yang, Krinos Li et al.

Understanding complete musical scores entails integrated reasoning over pitch, rhythm, harmony, and large-scale structure, yet the ability of Large Language Models and Vision-Language Models to interpret full musical notation remains insufficiently examined. We introduce the Musical Score Understanding Benchmark (MSU-Bench), the first large-scale, human-curated benchmark for score-level musical understanding across textual (ABC notation) and visual (PDF) modalities. MSU-Bench contains 1,800 generative Question-Answering pairs from works by Bach, Beethoven, Chopin, Debussy, and others, organised into four levels of increasing difficulty, ranging from onset information to texture and form. Evaluations of more than fifteen state-of-the-art models, in both zero-shot and fine-tuned settings, reveal pronounced modality gaps, unstable level-wise performance, and challenges in maintaining multilevel correctness. Fine-tuning substantially improves results across modalities while preserving general knowledge, positioning MSU-Bench as a robust foundation for future research in multimodal reasoning. To facilitate further research, we publicly release MSU-Bench and all associated resources.

Zhenxuan Zhang, Peiyuan Jing, Zi Wang et al.

Synthesizing high-quality images from low-field MRI holds significant potential. Low-field MRI is cheaper, more accessible, and safer, but suffers from low resolution and poor signal-to-noise ratio. This synthesis process can reduce reliance on costly acquisitions and expand data availability. However, synthesizing high-field MRI still suffers from a clinical fidelity gap. There is a need to preserve anatomical fidelity, enhance fine-grained structural details, and bridge domain gaps in image contrast. To address these issues, we propose a \emph{cyclic self-supervised diffusion (CSS-Diff)} framework for high-field MRI synthesis from real low-field MRI data. Our core idea is to reformulate diffusion-based synthesis under a cycle-consistent constraint. It enforces anatomical preservation throughout the generative process rather than just relying on paired pixel-level supervision. The CSS-Diff framework further incorporates two novel processes. The slice-wise gap perception network aligns inter-slice inconsistencies via contrastive learning. The local structure correction network enhances local feature restoration through self-reconstruction of masked and perturbed patches. Extensive experiments on cross-field synthesis tasks demonstrate the effectiveness of our method, achieving state-of-the-art performance (e.g., 31.80 $\pm$ 2.70 dB in PSNR, 0.943 $\pm$ 0.102 in SSIM, and 0.0864 $\pm$ 0.0689 in LPIPS). Beyond pixel-wise fidelity, our method also preserves fine-grained anatomical structures compared with the original low-field MRI (e.g., left cerebral white matter error drops from 12.1$\%$ to 2.1$\%$, cortex from 4.2$\%$ to 3.7$\%$). To conclude, our CSS-Diff can synthesize images that are both quantitatively reliable and anatomically consistent.