Xiaofeng Yang

Mingzhe Hu, Zach Eidex, Shansong Wang et al.

Radiology, radiation oncology, and medical physics require decision-making that integrates medical images, textual reports, and quantitative data under high-stakes conditions. With the introduction of GPT-5, it is critical to assess whether recent advances in large multimodal models translate into measurable gains in these safety-critical domains. We present a targeted zero-shot evaluation of GPT-5 and its smaller variants (GPT-5-mini, GPT-5-nano) against GPT-4o across three representative tasks. We present a targeted zero-shot evaluation of GPT-5 and its smaller variants (GPT-5-mini, GPT-5-nano) against GPT-4o across three representative tasks: (1) VQA-RAD, a benchmark for visual question answering in radiology; (2) SLAKE, a semantically annotated, multilingual VQA dataset testing cross-modal grounding; and (3) a curated Medical Physics Board Examination-style dataset of 150 multiple-choice questions spanning treatment planning, dosimetry, imaging, and quality assurance. Across all datasets, GPT-5 achieved the highest accuracy, with substantial gains over GPT-4o up to +20.00% in challenging anatomical regions such as the chest-mediastinal, +13.60% in lung-focused questions, and +11.44% in brain-tissue interpretation. On the board-style physics questions, GPT-5 attained 90.7% accuracy (136/150), exceeding the estimated human passing threshold, while GPT-4o trailed at 78.0%. These results demonstrate that GPT-5 delivers consistent and often pronounced performance improvements over GPT-4o in both image-grounded reasoning and domain-specific numerical problem-solving, highlighting its potential to augment expert workflows in medical imaging and therapeutic physics.

Yang Lei, Luke A. Matkovic, Justin Roper et al.

This paper aims to create a deep learning framework that can estimate the deformation vector field (DVF) for directly registering abdominal MRI-CT images. The proposed method assumed a diffeomorphic deformation. By using topology-preserved deformation features extracted from the probabilistic diffeomorphic registration model, abdominal motion can be accurately obtained and utilized for DVF estimation. The model integrated Swin transformers, which have demonstrated superior performance in motion tracking, into the convolutional neural network (CNN) for deformation feature extraction. The model was optimized using a cross-modality image similarity loss and a surface matching loss. To compute the image loss, a modality-independent neighborhood descriptor (MIND) was used between the deformed MRI and CT images. The surface matching loss was determined by measuring the distance between the warped coordinates of the surfaces of contoured structures on the MRI and CT images. The deformed MRI image was assessed against the CT image using the target registration error (TRE), Dice similarity coefficient (DSC), and mean surface distance (MSD) between the deformed contours of the MRI image and manual contours of the CT image. When compared to only rigid registration, DIR with the proposed method resulted in an increase of the mean DSC values of the liver and portal vein from 0.850 and 0.628 to 0.903 and 0.763, a decrease of the mean MSD of the liver from 7.216 mm to 3.232 mm, and a decrease of the TRE from 26.238 mm to 8.492 mm. The proposed deformable image registration method based on a diffeomorphic transformer provides an effective and efficient way to generate an accurate DVF from an MRI-CT image pair of the abdomen. It could be utilized in the current treatment planning workflow for liver radiotherapy.

Zach Eidex, Mojtaba Safari, Jie Ding et al.

Objective: Gadolinium-based contrast agents (GBCAs) are commonly employed with T1w MRI to enhance lesion visualization but are restricted in patients at risk of nephrogenic systemic fibrosis and variations in GBCA administration can introduce imaging inconsistencies. This study develops an efficient 3D deep-learning framework to generate T1-contrast enhanced images (T1C) from pre-contrast multiparametric MRI. Approach: We propose the 3D latent rectified flow (T1C-RFlow) model for generating high-quality T1C images. First, T1w and T2-FLAIR images are input into a pretrained autoencoder to acquire an efficient latent space representation. A rectified flow diffusion model is then trained in this latent space representation. The T1C-RFlow model was trained on a curated dataset comprised of the BraTS 2024 glioma (GLI; 1480 patients), meningioma (MEN; 1141 patients), and metastases (MET; 1475 patients) datasets. Selected patients were split into train (N=2860), validation (N=612), and test (N=614) sets. Results: Both qualitative and quantitative results demonstrate that the T1C-RFlow model outperforms benchmark 3D models (pix2pix, DDPM, Diffusion Transformers (DiT-3D)) trained in the same latent space. T1C-RFlow achieved the following metrics - GLI: NMSE 0.044 +/- 0.047, SSIM 0.935 +/- 0.025; MEN: NMSE 0.046 +/- 0.029, SSIM 0.937 +/- 0.021; MET: NMSE 0.098 +/- 0.088, SSIM 0.905 +/- 0.082. T1C-RFlow had the best tumor reconstruction performance and significantly faster denoising times (6.9 s/volume, 200 steps) than conventional DDPM models in both latent space (37.7s, 1000 steps) and patch-based in image space (4.3 hr/volume). Significance: Our proposed method generates synthetic T1C images that closely resemble ground truth T1C in much less time than previous diffusion models. Further development may permit a practical method for contrast-agent-free MRI for brain tumors.