Jiancheng Yang

Liang Jin, Shixuan Gu, Donglai Wei et al. · harvard

Automatic rib labeling and anatomical centerline extraction are common prerequisites for various clinical applications. Prior studies either use in-house datasets that are inaccessible to communities, or focus on rib segmentation that neglects the clinical significance of rib labeling. To address these issues, we extend our prior dataset (RibSeg) on the binary rib segmentation task to a comprehensive benchmark, named RibSeg v2, with 660 CT scans (15,466 individual ribs in total) and annotations manually inspected by experts for rib labeling and anatomical centerline extraction. Based on the RibSeg v2, we develop a pipeline including deep learning-based methods for rib labeling, and a skeletonization-based method for centerline extraction. To improve computational efficiency, we propose a sparse point cloud representation of CT scans and compare it with standard dense voxel grids. Moreover, we design and analyze evaluation metrics to address the key challenges of each task. Our dataset, code, and model are available online to facilitate open research at https://github.com/M3DV/RibSeg

Jianning Li, Zongwei Zhou, Jiancheng Yang et al.

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback

Chinmay Prabhakar, Hongwei Bran Li, Jiancheng Yang et al.

Self-supervised learning has attracted increasing attention as it learns data-driven representation from data without annotations. Vision transformer-based autoencoder (ViT-AE) by He et al. (2021) is a recent self-supervised learning technique that employs a patch-masking strategy to learn a meaningful latent space. In this paper, we focus on improving ViT-AE (nicknamed ViT-AE++) for a more effective representation of 2D and 3D medical images. We propose two new loss functions to enhance the representation during training. The first loss term aims to improve self-reconstruction by considering the structured dependencies and indirectly improving the representation. The second loss term leverages contrastive loss to optimize the representation from two randomly masked views directly. We extended ViT-AE++ to a 3D fashion for volumetric medical images as an independent contribution. We extensively evaluate ViT-AE++ on both natural images and medical images, demonstrating consistent improvement over vanilla ViT-AE and its superiority over other contrastive learning approaches. Codes are here: https://github.com/chinmay5/vit_ae_plus_plus.git.

Xiaoyang Huang, Jiancheng Yang, Yanjun Wang et al.

3D shape analysis has been widely explored in the era of deep learning. Numerous models have been developed for various 3D data representation formats, e.g., MeshCNN for meshes, PointNet for point clouds and VoxNet for voxels. In this study, we present Representation-Agnostic Shape Fields (RASF), a generalizable and computation-efficient shape embedding module for 3D deep learning. RASF is implemented with a learnable 3D grid with multiple channels to store local geometry. Based on RASF, shape embeddings for various 3D shape representations (point clouds, meshes and voxels) are retrieved by coordinate indexing. While there are multiple ways to optimize the learnable parameters of RASF, we provide two effective schemes among all in this paper for RASF pre-training: shape reconstruction and normal estimation. Once trained, RASF becomes a plug-and-play performance booster with negligible cost. Extensive experiments on diverse 3D representation formats, networks and applications, validate the universal effectiveness of the proposed RASF. Code and pre-trained models are publicly available https://github.com/seanywang0408/RASF

Jiancheng Yang, Rui Shi, Udaranga Wickramasinghe et al.

The human annotations are imperfect, especially when produced by junior practitioners. Multi-expert consensus is usually regarded as golden standard, while this annotation protocol is too expensive to implement in many real-world projects. In this study, we propose a method to refine human annotation, named Neural Annotation Refinement (NeAR). It is based on a learnable implicit function, which decodes a latent vector into represented shape. By integrating the appearance as an input of implicit functions, the appearance-aware NeAR fixes the annotation artefacts. Our method is demonstrated on the application of adrenal gland analysis. We first show that the NeAR can repair distorted golden standards on a public adrenal gland segmentation dataset. Besides, we develop a new Adrenal gLand ANalysis (ALAN) dataset with the proposed NeAR, where each case consists of a 3D shape of adrenal gland and its diagnosis label (normal vs. abnormal) assigned by experts. We show that models trained on the shapes repaired by the NeAR can diagnose adrenal glands better than the original ones. The ALAN dataset will be open-source, with 1,584 shapes for adrenal gland diagnosis, which serves as a new benchmark for medical shape analysis. Code and dataset are available at https://github.com/M3DV/NeAR.

Ziqiao Weng, Jiancheng Yang, Dongnan Liu et al.

Accurate segmentation of pulmonary airways and vessels is crucial for the diagnosis and treatment of pulmonary diseases. However, current deep learning approaches suffer from disconnectivity issues that hinder their clinical usefulness. To address this challenge, we propose a post-processing approach that leverages a data-driven method to repair the topology of disconnected pulmonary tubular structures. Our approach formulates the problem as a keypoint detection task, where a neural network is trained to predict keypoints that can bridge disconnected components. We use a training data synthesis pipeline that generates disconnected data from complete pulmonary structures. Moreover, the new Pulmonary Tree Repairing (PTR) dataset is publicly available, which comprises 800 complete 3D models of pulmonary airways, arteries, and veins, as well as the synthetic disconnected data. Our code and data are available at https://github.com/M3DV/pulmonary-tree-repairing.

Kaiming Kuang, Li Zhang, Jingyu Li et al.

3D reconstruction of pulmonary segments plays an important role in surgical treatment planning of lung cancer, which facilitates preservation of pulmonary function and helps ensure low recurrence rates. However, automatic reconstruction of pulmonary segments remains unexplored in the era of deep learning. In this paper, we investigate what makes for automatic reconstruction of pulmonary segments. First and foremost, we formulate, clinically and geometrically, the anatomical definitions of pulmonary segments, and propose evaluation metrics adhering to these definitions. Second, we propose ImPulSe (Implicit Pulmonary Segment), a deep implicit surface model designed for pulmonary segment reconstruction. The automatic reconstruction of pulmonary segments by ImPulSe is accurate in metrics and visually appealing. Compared with canonical segmentation methods, ImPulSe outputs continuous predictions of arbitrary resolutions with higher training efficiency and fewer parameters. Lastly, we experiment with different network inputs to analyze what matters in the task of pulmonary segment reconstruction. Our code is available at https://github.com/M3DV/ImPulSe.

Zhihao Li, Jiancheng Yang, Yongchao Xu et al.

Pulmonary nodules and masses are crucial imaging features in lung cancer screening that require careful management in clinical diagnosis. Despite the success of deep learning-based medical image segmentation, the robust performance on various sizes of lesions of nodule and mass is still challenging. In this paper, we propose a multi-scale neural network with scale-aware test-time adaptation to address this challenge. Specifically, we introduce an adaptive Scale-aware Test-time Click Adaptation method based on effortlessly obtainable lesion clicks as test-time cues to enhance segmentation performance, particularly for large lesions. The proposed method can be seamlessly integrated into existing networks. Extensive experiments on both open-source and in-house datasets consistently demonstrate the effectiveness of the proposed method over some CNN and Transformer-based segmentation methods. Our code is available at https://github.com/SplinterLi/SaTTCA

Minghui Zhang, Yangqian Wu, Hanxiao Zhang et al. · harvard

Open international challenges are becoming the de facto standard for assessing computer vision and image analysis algorithms. In recent years, new methods have extended the reach of pulmonary airway segmentation that is closer to the limit of image resolution. Since EXACT'09 pulmonary airway segmentation, limited effort has been directed to quantitative comparison of newly emerged algorithms driven by the maturity of deep learning based approaches and clinical drive for resolving finer details of distal airways for early intervention of pulmonary diseases. Thus far, public annotated datasets are extremely limited, hindering the development of data-driven methods and detailed performance evaluation of new algorithms. To provide a benchmark for the medical imaging community, we organized the Multi-site, Multi-domain Airway Tree Modeling (ATM'22), which was held as an official challenge event during the MICCAI 2022 conference. ATM'22 provides large-scale CT scans with detailed pulmonary airway annotation, including 500 CT scans (300 for training, 50 for validation, and 150 for testing). The dataset was collected from different sites and it further included a portion of noisy COVID-19 CTs with ground-glass opacity and consolidation. Twenty-three teams participated in the entire phase of the challenge and the algorithms for the top ten teams are reviewed in this paper. Quantitative and qualitative results revealed that deep learning models embedded with the topological continuity enhancement achieved superior performance in general. ATM'22 challenge holds as an open-call design, the training data and the gold standard evaluation are available upon successful registration via its homepage.

Rui Xu, Yong Luo, Bo Du et al.

Convolutional neural networks (CNNs) have been demonstrated to be highly effective in the field of pulmonary nodule detection. However, existing CNN based pulmonary nodule detection methods lack the ability to capture long-range dependencies, which is vital for global information extraction. In computer vision tasks, non-local operations have been widely utilized, but the computational cost could be very high for 3D computed tomography (CT) images. To address this issue, we propose a long short slice-aware network (LSSANet) for the detection of pulmonary nodules. In particular, we develop a new non-local mechanism termed long short slice grouping (LSSG), which splits the compact non-local embeddings into a short-distance slice grouped one and a long-distance slice grouped counterpart. This not only reduces the computational burden, but also keeps long-range dependencies among any elements across slices and in the whole feature map. The proposed LSSG is easy-to-use and can be plugged into many pulmonary nodule detection networks. To verify the performance of LSSANet, we compare with several recently proposed and competitive detection approaches based on 2D/3D CNN. Promising evaluation results on the large-scale PN9 dataset demonstrate the effectiveness of our method. Code is at https://github.com/Ruixxxx/LSSANet.

Weiyi Zhang, Siyu Huang, Jiancheng Yang et al.

Fundus Fluorescein Angiography (FFA) is a critical tool for assessing retinal vascular dynamics and aiding in the diagnosis of eye diseases. However, its invasive nature and less accessibility compared to Color Fundus (CF) images pose significant challenges. Current CF to FFA translation methods are limited to static generation. In this work, we pioneer dynamic FFA video generation from static CF images. We introduce an autoregressive GAN for smooth, memory-saving frame-by-frame FFA synthesis. To enhance the focus on dynamic lesion changes in FFA regions, we design a knowledge mask based on clinical experience. Leveraging this mask, our approach integrates innovative knowledge mask-guided techniques, including knowledge-boosted attention, knowledge-aware discriminators, and mask-enhanced patchNCE loss, aimed at refining generation in critical areas and addressing the pixel misalignment challenge. Our method achieves the best FVD of 1503.21 and PSNR of 11.81 compared to other common video generation approaches. Human assessment by an ophthalmologist confirms its high generation quality. Notably, our knowledge mask surpasses supervised lesion segmentation masks, offering a promising non-invasive alternative to traditional FFA for research and clinical applications. The code is available at https://github.com/Michi-3000/Fundus2Video.

Zhongying Deng, Cheng Tang, Ziyan Huang et al. · pku

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

Rui Xu, Zhi Liu, Yong Luo et al.

Lung cancer is the leading cause of cancer death worldwide. The best solution for lung cancer is to diagnose the pulmonary nodules in the early stage, which is usually accomplished with the aid of thoracic computed tomography (CT). As deep learning thrives, convolutional neural networks (CNNs) have been introduced into pulmonary nodule detection to help doctors in this labor-intensive task and demonstrated to be very effective. However, the current pulmonary nodule detection methods are usually domain-specific, and cannot satisfy the requirement of working in diverse real-world scenarios. To address this issue, we propose a slice grouped domain attention (SGDA) module to enhance the generalization capability of the pulmonary nodule detection networks. This attention module works in the axial, coronal, and sagittal directions. In each direction, we divide the input feature into groups, and for each group, we utilize a universal adapter bank to capture the feature subspaces of the domains spanned by all pulmonary nodule datasets. Then the bank outputs are combined from the perspective of domain to modulate the input group. Extensive experiments demonstrate that SGDA enables substantially better multi-domain pulmonary nodule detection performance compared with the state-of-the-art multi-domain learning methods.

Jiancheng Yang, Hongwei Bran Li, Donglai Wei

This study investigates the transformative potential of Large Language Models (LLMs), such as OpenAI ChatGPT, in medical imaging. With the aid of public data, these models, which possess remarkable language understanding and generation capabilities, are augmenting the interpretive skills of radiologists, enhancing patient-physician communication, and streamlining clinical workflows. The paper introduces an analytic framework for presenting the complex interactions between LLMs and the broader ecosystem of medical imaging stakeholders, including businesses, insurance entities, governments, research institutions, and hospitals (nicknamed BIGR-H). Through detailed analyses, illustrative use cases, and discussions on the broader implications and future directions, this perspective seeks to raise discussion in strategic planning and decision-making in the era of AI-enabled healthcare.

Kangxian Xie, Jiancheng Yang, Donglai Wei et al.

Pulmonary diseases rank prominently among the principal causes of death worldwide. Curing them will require, among other things, a better understanding of the complex 3D tree-shaped structures within the pulmonary system, such as airways, arteries, and veins. Traditional approaches using high-resolution image stacks and standard CNNs on dense voxel grids face challenges in computational efficiency, limited resolution, local context, and inadequate preservation of shape topology. Our method addresses these issues by shifting from dense voxel to sparse point representation, offering better memory efficiency and global context utilization. However, the inherent sparsity in point representation can lead to a loss of crucial connectivity in tree-shaped structures. To mitigate this, we introduce graph learning on skeletonized structures, incorporating differentiable feature fusion for improved topology and long-distance context capture. Furthermore, we employ an implicit function for efficient conversion of sparse representations into dense reconstructions end-to-end. The proposed method not only delivers state-of-the-art performance in labeling accuracy, both overall and at key locations, but also enables efficient inference and the generation of closed surface shapes. Addressing data scarcity in this field, we have also curated a comprehensive dataset to validate our approach. Data and code are available at \url{https://github.com/M3DV/pulmonary-tree-labeling}.

Danli Shi, Weiyi Zhang, Jiancheng Yang et al.

Early detection of eye diseases like glaucoma, macular degeneration, and diabetic retinopathy is crucial for preventing vision loss. While artificial intelligence (AI) foundation models hold significant promise for addressing these challenges, existing ophthalmic foundation models primarily focus on a single modality, whereas diagnosing eye diseases requires multiple modalities. A critical yet often overlooked aspect is harnessing the multi-view information across various modalities for the same patient. Additionally, due to the long-tail nature of ophthalmic diseases, standard fully supervised or unsupervised learning approaches often struggle. Therefore, it is essential to integrate clinical text to capture a broader spectrum of diseases. We propose EyeCLIP, a visual-language foundation model developed using over 2.77 million multi-modal ophthalmology images with partial text data. To fully leverage the large multi-modal unlabeled and labeled data, we introduced a pretraining strategy that combines self-supervised reconstructions, multi-modal image contrastive learning, and image-text contrastive learning to learn a shared representation of multiple modalities. Through evaluation using 14 benchmark datasets, EyeCLIP can be transferred to a wide range of downstream tasks involving ocular and systemic diseases, achieving state-of-the-art performance in disease classification, visual question answering, and cross-modal retrieval. EyeCLIP represents a significant advancement over previous methods, especially showcasing few-shot, even zero-shot capabilities in real-world long-tail scenarios.

Ziyu Gao, Xinyuan Wu, Xiaolan Chen et al.

Ophthalmic decision-making depends on subtle lesion-scale cues interpreted across multimodal imaging and over time, yet most medical foundation models remain static and degrade under modality and acquisition shifts. Here we introduce EyeWorld, a generative world model that conceptualizes the eye as a partially observed dynamical system grounded in clinical imaging. EyeWorld learns an observation-stable latent ocular state shared across modalities, unifying fine-grained parsing, structure-preserving cross-modality translation and quality-robust enhancement within a single framework. Longitudinal supervision further enables time-conditioned state transitions, supporting forecasting of clinically meaningful progression while preserving stable anatomy. By moving from static representation learning to explicit dynamical modeling, EyeWorld provides a unified approach to robust multimodal interpretation and prognosis-oriented simulation in medicine.

Dingyi Rong, Jiancheng Yang, Bingbing Ni et al.

Projection map (PM) from optical coherence tomography (OCT) B-scan is an important tool to diagnose retinal diseases, which typically requires retinal layer segmentation. In this study, we present a novel end-to-end framework to predict PMs from B-scans. Instead of segmenting retinal layers explicitly, we represent them implicitly as predicted coordinates. By pixel interpolation on uniformly sampled coordinates between retinal layers, the corresponding PMs could be easily obtained with pooling. Notably, all the operators are differentiable; therefore, this Differentiable Projection Module (DPM) enables end-to-end training with the ground truth of PMs rather than retinal layer segmentation. Our framework produces high-quality PMs, significantly outperforming baselines, including a vanilla CNN without DPM and an optimization-based DPM without a deep prior. Furthermore, the proposed DPM, as a novel neural representation of areas/volumes between curves/surfaces, could be of independent interest for geometric deep learning.

Hieu Le, Jingyi Xu, Nicolas Talabot et al.

Accurate 3D models of the human heart require not only correct outer surfaces but also realistic inner structures, such as the ventricles, atria, and myocardial layers. Approaches relying on implicit surfaces, such as signed distance functions (SDFs), are primarily designed for single watertight surfaces, making them ill-suited for multi-layered anatomical structures. They often produce gaps or overlaps in shared boundaries. Unsigned distance functions (UDFs) can model non-watertight geometries but are harder to optimize, while voxel-based methods are limited in resolution and struggle to produce smooth, anatomically realistic surfaces. We introduce a pairwise-constrained SDF approach that models the heart as a set of interdependent SDFs, each representing a distinct anatomical component. By enforcing proper contact between adjacent SDFs, we ensure that they form anatomically correct shared walls, preserving the internal structure of the heart and preventing overlaps, or unwanted gaps. Our method significantly improves inner structure accuracy over single-SDF, UDF-based, voxel-based, and segmentation-based reconstructions. We further demonstrate its generalizability by applying it to a vertebrae dataset, preventing unwanted contact between structures.

Kangxian Xie, Jiancheng Yang, Nandor Pinter et al.

Accurate 3D anatomical segmentation is essential for clinical diagnosis and surgical planning. However, automated models frequently generate suboptimal shape predictions due to factors such as limited and imbalanced training data, inadequate labeling quality, and distribution shifts between training and deployment settings. A natural solution is to iteratively refine the predicted shape based on the radiologists' verbal instructions. However, this is hindered by the scarcity of paired data that explicitly links erroneous shapes to corresponding corrective instructions. As an initial step toward addressing this limitation, we introduce CoWTalk, a benchmark comprising 3D arterial anatomies with controllable synthesized anatomical errors and their corresponding repairing instructions. Building on this benchmark, we further propose an iterative refinement model that represents 3D shapes as vector sets and interacts with textual instructions to progressively update the target shape. Experimental results demonstrate that our method achieves significant improvements over corrupted inputs and competitive baselines, highlighting the feasibility of language-driven clinician-in-the-loop refinement for 3D medical shapes modeling.

Jiazhen Pan, Weixiang Shen, Jun Li et al.

Medical diagnosis is not a single prediction from a fully specified vignette. It is a sequential workup: clinicians decide what evidence to obtain, revise a differential diagnosis, and stop when the diagnosis is sufficiently supported. Most medical AI benchmarks instead reveal the relevant context upfront and score only the final answer, making unsupported correct guesses, premature closure, inefficient workups, and poor uncertainty updating invisible. We introduce DDX-TRACE, a physician-adjudicated benchmark for multimodal neuroradiology that evaluates diagnostic trajectories under hidden evidence over 211 challenging cases. Each case begins with limited clinical history; models request imaging studies in free form, receive matched image bundles when available, update a probabilistic differential diagnosis after each turn, and stop with a localized final diagnosis. Evaluating state-of-the-art VLMs, we find that final diagnosis scores can substantially misrepresent workup quality: models may guess plausible diagnoses without essential evidence, request useful studies but misinterpret raw images, or acquire evidence inefficiently while updating uncertainty poorly. Controlled evidence variants isolate bottlenecks in planning, visual evidence extraction, and downstream differential reasoning. DDX-TRACE shifts medical AI evaluation from final answers to evidence-supported diagnostic trajectories.

Simon Ging, Philipp Arnold, Sebastian Walter et al.

Recent 3D CT vision-language models align volumes with reports via contrastive pretraining, but typically rely on limited public data and provide only coarse global supervision. We train a 3D CT vision-language model on 98k report-volume pairs (50k patients) collected at a single hospital, combined with public datasets, using SigLIP-style contrastive pretraining together with prompt-based disease supervision in the shared vision-text embedding space. On CT-RATE, our model achieves state-of-the-art text-to-image retrieval (R@10 31.5 vs. 22.2) and competitive disease classification (AUC 83.8 vs. 83.8), with consistent results on Rad-ChestCT (AUC 77.0 vs. 77.3). We further observe that radiologists routinely reference specific images within their reports (e.g., ``series X, image Y''), linking textual descriptions to precise axial locations. We automatically mine 262k such snippet-slice pairs and introduce the task of intra-scan snippet localization -- predicting the axial depth referred to by a text snippet -- reducing mean absolute error to 36.3 mm at 12 mm feature resolution, compared with 67.0 mm for the best baseline. Adding this localization objective leaves retrieval and classification broadly unchanged within confidence bounds, yielding a single unified model for retrieval, classification, and intra-scan grounding.

Hanjiang Zhu, Pedro Martelleto Rezende, Zhang Yang et al.

This work proposes Bonnet, an ultra-fast sparse-volume pipeline for whole-body bone segmentation from CT scans. Accurate bone segmentation is important for surgical planning and anatomical analysis, but existing 3D voxel-based models such as nnU-Net and STU-Net require heavy computation and often take several minutes per scan, which limits time-critical use. The proposed Bonnet addresses this by integrating a series of novel framework components including HU-based bone thresholding, patch-wise inference with a sparse spconv-based U-Net, and multi-window fusion into a full-volume prediction. Trained on TotalSegmentator and evaluated without additional tuning on RibSeg, CT-Pelvic1K, and CT-Spine1K, Bonnet achieves high Dice across ribs, pelvis, and spine while running in only 2.69 seconds per scan on an RTX A6000. Compared to strong voxel baselines, Bonnet attains a similar accuracy but reduces inference time by roughly 25x on the same hardware and tiling setup. The toolkit and pre-trained models will be released at https://github.com/HINTLab/Bonnet.

Ziqiao Weng, Jiancheng Yang, Kangxian Xie et al.

Pulmonary trees extracted from CT images frequently exhibit topological incompleteness, such as missing or disconnected branches, which substantially degrades downstream anatomical analysis and limits the applicability of existing pulmonary tree modeling pipelines. Current approaches typically rely on dense volumetric processing or explicit graph reasoning, leading to limited efficiency and reduced robustness under realistic structural corruption. We propose TopoField, a topology-aware implicit modeling framework that treats topology repair as a first-class modeling problem and enables unified multi-task inference for pulmonary tree analysis. TopoField represents pulmonary anatomy using sparse surface and skeleton point clouds and learns a continuous implicit field that supports topology repair without relying on complete or explicit disconnection annotations, by training on synthetically introduced structural disruptions over \textit{already} incomplete trees. Building upon the repaired implicit representation, anatomical labeling and lung segment reconstruction are jointly inferred through task-specific implicit functions within a single forward pass.Extensive experiments on the Lung3D+ dataset demonstrate that TopoField consistently improves topological completeness and achieves accurate anatomical labeling and lung segment reconstruction under challenging incomplete scenarios. Owing to its implicit formulation, TopoField attains high computational efficiency, completing all tasks in just over one second per case, highlighting its practicality for large-scale and time-sensitive clinical applications. Code and data will be available at https://github.com/HINTLab/TopoField.

Hantao Zhang, Yuhe Liu, Jiancheng Yang et al.

Patient data from real-world clinical practice often suffers from data scarcity and long-tail imbalances, leading to biased outcomes or algorithmic unfairness. This study addresses these challenges by generating lesion-containing image-segmentation pairs from lesion-free images. Previous efforts in medical imaging synthesis have struggled with separating lesion information from background, resulting in low-quality backgrounds and limited control over the synthetic output. Inspired by diffusion-based image inpainting, we propose LeFusion, a lesion-focused diffusion model. By redesigning the diffusion learning objectives to focus on lesion areas, we simplify the learning process and improve control over the output while preserving high-fidelity backgrounds by integrating forward-diffused background contexts into the reverse diffusion process. Additionally, we tackle two major challenges in lesion texture synthesis: 1) multi-peak and 2) multi-class lesions. We introduce two effective strategies: histogram-based texture control and multi-channel decomposition, enabling the controlled generation of high-quality lesions in difficult scenarios. Furthermore, we incorporate lesion mask diffusion, allowing control over lesion size, location, and boundary, thus increasing lesion diversity. Validated on 3D cardiac lesion MRI and lung nodule CT datasets, LeFusion-generated data significantly improves the performance of state-of-the-art segmentation models, including nnUNet and SwinUNETR. Code and model are available at https://github.com/M3DV/LeFusion.

Yinghong Yu, Guangyuan Li, Jiancheng Yang

Large-scale 2D foundation models exhibit strong transferable representations, yet extending them to 3D volumetric data typically requires retraining, adapters, or architectural redesign. We introduce PlaneCycle, a training-free, adapter-free operator for architecture-agnostic 2D-to-3D lifting of foundation models. PlaneCycle reuses the original pretrained 2D backbone by cyclically distributing spatial aggregation across orthogonal HW, DW, and DH planes throughout network depth, enabling progressive 3D fusion while preserving pretrained inductive biases. The method introduces no additional parameters and is applicable to arbitrary 2D networks. Using pretrained DINOv3 models, we evaluate PlaneCycle on six 3D classification and three 3D segmentation benchmarks. Without any training, the lifted models exhibit intrinsic 3D fusion capability and, under linear probing, outperform slice-wise 2D baselines and strong 3D counterparts, approaching the performance of fully trained models. With full fine-tuning, PlaneCycle matches standard 3D architectures, highlighting its potential as a seamless and practical 2D-to-3D lifting operator. These results demonstrate that 3D capability can be unlocked from pretrained 2D foundation models without structural modification or retraining. Code is available at https://github.com/HINTLab/PlaneCycle.

Yihong Chen, Jiancheng Yang, Deniz Sayin Mercadier et al.

We present a novel approach to reconstruction of 3D cardiac motion from sparse intraoperative data. While existing methods can accurately reconstruct 3D organ geometries from full 3D volumetric imaging, they cannot be used during surgical interventions where usually limited observed data, such as a few 2D frames or 1D signals, is available in real-time. We propose a versatile framework for reconstructing 3D motion from such partial data. It discretizes the 3D space into a deformable tetrahedral grid with signed distance values, providing implicit unlimited resolution while maintaining explicit control over motion dynamics. Given an initial 3D model reconstructed from pre-operative full volumetric data, our system, equipped with an universal observation encoder, can reconstruct coherent 3D cardiac motion from full 3D volumes, a few 2D MRI slices or even 1D signals. Extensive experiments on cardiac intervention scenarios demonstrate our ability to generate plausible and anatomically consistent 3D motion reconstructions from various sparse real-time observations, highlighting its potential for multimodal cardiac imaging. Our code and model will be made available at https://github.com/Scalsol/MedTet.

Hantao Zhang, Yuhe Liu, Jiancheng Yang et al.

Accurate medical image segmentation is crucial for precise anatomical delineation. Deep learning models like U-Net have shown great success but depend heavily on large datasets and struggle with domain shifts, complex structures, and limited training samples. Recent studies have explored diffusion models for segmentation by iteratively refining masks. However, these methods still retain the conventional image-to-mask mapping, making them highly sensitive to input data, which hampers stability and generalization. In contrast, we introduce DiffAtlas, a novel generative framework that models both images and masks through diffusion during training, effectively ``GenAI-fying'' atlas-based segmentation. During testing, the model is guided to generate a specific target image-mask pair, from which the corresponding mask is obtained. DiffAtlas retains the robustness of the atlas paradigm while overcoming its scalability and domain-specific limitations. Extensive experiments on CT and MRI across same-domain, cross-modality, varying-domain, and different data-scale settings using the MMWHS and TotalSegmentator datasets demonstrate that our approach outperforms existing methods, particularly in limited-data and zero-shot modality segmentation. Code is available at https://github.com/M3DV/DiffAtlas.

Hantao Zhang, Weidong Guo, Yuhe Liu et al.

Data-driven medical AI is traditionally formulated as a discriminative mapping from input $X$ to output $Y$ via a learned function $f$, which does not generalize well across heterogeneous data and modalities encountered in real-world clinical settings. In this work, we propose a fundamentally different, generative paradigm. We model the joint distribution $P(X,Y)$ using diffusion models and reframe inference as a test-time output optimization problem. By guiding the generative process to match observed inputs, our framework enables flexible, gradient-based conditioning at inference time without architectural changes or retraining, effectively supporting arbitrary and previously unseen combinations of observations. Extensive experiments demonstrate strong performance across standard and cross-modality medical image segmentation, few-shot segmentation with only 2 or 4 training samples, degraded-input segmentation, shape completion from sparse and partial observations, and zero-shot application to demonstrate generality. To support these evaluations, we curated and released a large-scale text-shape dataset derived from MedShapeNet. Our results highlight the versatility of generative joint modeling as a foundation for reusable, task-agnostic medical AI systems.

Yuxuan Ou, Ning Bi, Jiazhen Pan et al.

While contrast-enhanced CT (CECT) is standard for assessing abdominal aortic aneurysms (AAA), the required iodinated contrast agents pose significant risks, including nephrotoxicity, patient allergies, and environmental harm. To reduce contrast agent use, recent deep learning methods have focused on generating synthetic CECT from non-contrast CT (NCCT) scans. However, most adopt a multi-stage pipeline that first generates images and then performs segmentation, which leads to error accumulation and fails to leverage shared semantic and anatomical structures. To address this, we propose a unified deep learning framework that generates synthetic CECT images from NCCT scans while simultaneously segmenting the aortic lumen and thrombus. Our approach integrates conditional diffusion models (CDM) with multi-task learning, enabling end-to-end joint optimization of image synthesis and anatomical segmentation. Unlike previous multitask diffusion models, our approach requires no initial predictions (e.g., a coarse segmentation mask), shares both encoder and decoder parameters across tasks, and employs a semi-supervised training strategy to learn from scans with missing segmentation labels, a common constraint in real-world clinical data. We evaluated our method on a cohort of 264 patients, where it consistently outperformed state-of-the-art single-task and multi-stage models. For image synthesis, our model achieved a PSNR of 25.61 dB, compared to 23.80 dB from a single-task CDM. For anatomical segmentation, it improved the lumen Dice score to 0.89 from 0.87 and the challenging thrombus Dice score to 0.53 from 0.48 (nnU-Net). These segmentation enhancements led to more accurate clinical measurements, reducing the lumen diameter MAE to 4.19 mm from 5.78 mm and the thrombus area error to 33.85% from 41.45% when compared to nnU-Net. Code is available at https://github.com/yuxuanou623/AortaDiff.git.

Kangxian Xie, Yufei Zhu, Kaiming Kuang et al.

High-quality 3D reconstruction of pulmonary segments plays a crucial role in segmentectomy and surgical treatment planning for lung cancer. Due to the resolution requirement of the target reconstruction, conventional deep learning-based methods often suffer from computational resource constraints or limited granularity. Conversely, implicit modeling is favored due to its computational efficiency and continuous representation at any resolution. We propose a neural implicit function-based method to learn a 3D surface to achieve anatomy-aware, precise pulmonary segment reconstruction, represented as a shape by deforming a learnable template. Additionally, we introduce two clinically relevant evaluation metrics to assess the reconstruction comprehensively. Further, due to the absence of publicly available shape datasets to benchmark reconstruction algorithms, we developed a shape dataset named Lung3D, including the 3D models of 800 labeled pulmonary segments and the corresponding airways, arteries, veins, and intersegmental veins. We demonstrate that the proposed approach outperforms existing methods, providing a new perspective for pulmonary segment reconstruction. Code and data will be available at https://github.com/M3DV/ImPulSe.

Sihan Shang, Jiancheng Yang, Zhenglong Sun et al.

In the realm of healthcare, the challenges of copyright protection and unauthorized third-party misuse are increasingly significant. Traditional methods for data copyright protection are applied prior to data distribution, implying that models trained on these data become uncontrollable. This paper introduces a novel approach, named DataCook, designed to safeguard the copyright of healthcare data during the deployment phase. DataCook operates by "cooking" the raw data before distribution, enabling the development of models that perform normally on this processed data. However, during the deployment phase, the original test data must be also "cooked" through DataCook to ensure normal model performance. This process grants copyright holders control over authorization during the deployment phase. The mechanism behind DataCook is by crafting anti-adversarial examples (AntiAdv), which are designed to enhance model confidence, as opposed to standard adversarial examples (Adv) that aim to confuse models. Similar to Adv, AntiAdv introduces imperceptible perturbations, ensuring that the data processed by DataCook remains easily understandable. We conducted extensive experiments on MedMNIST datasets, encompassing both 2D/3D data and the high-resolution variants. The outcomes indicate that DataCook effectively meets its objectives, preventing models trained on AntiAdv from analyzing unauthorized data effectively, without compromising the validity and accuracy of the data in legitimate scenarios. Code and data are available at https://github.com/MedMNIST/DataCook.

Jiancheng Yang, Rui Shi, Donglai Wei et al.

We introduce MedMNIST v2, a large-scale MNIST-like dataset collection of standardized biomedical images, including 12 datasets for 2D and 6 datasets for 3D. All images are pre-processed into a small size of 28x28 (2D) or 28x28x28 (3D) with the corresponding classification labels so that no background knowledge is required for users. Covering primary data modalities in biomedical images, MedMNIST v2 is designed to perform classification on lightweight 2D and 3D images with various dataset scales (from 100 to 100,000) and diverse tasks (binary/multi-class, ordinal regression, and multi-label). The resulting dataset, consisting of 708,069 2D images and 10,214 3D images in total, could support numerous research / educational purposes in biomedical image analysis, computer vision, and machine learning. We benchmark several baseline methods on MedMNIST v2, including 2D / 3D neural networks and open-source / commercial AutoML tools. The data and code are publicly available at https://medmnist.com/.

Jiancheng Yang, Yi He, Kaiming Kuang et al.

Modeling 3D context is essential for high-performance 3D medical image analysis. Although 2D networks benefit from large-scale 2D supervised pretraining, it is weak in capturing 3D context. 3D networks are strong in 3D context yet lack supervised pretraining. As an emerging technique, \emph{3D context fusion operator}, which enables conversion from 2D pretrained networks, leverages the advantages of both and has achieved great success. Existing 3D context fusion operators are designed to be spatially symmetric, i.e., performing identical operations on each 2D slice like convolutions. However, these operators are not truly equivariant to translation, especially when only a few 3D slices are used as inputs. In this paper, we propose a novel asymmetric 3D context fusion operator (A3D), which uses different weights to fuse 3D context from different 2D slices. Notably, A3D is NOT translation-equivariant while it significantly outperforms existing symmetric context fusion operators without introducing large computational overhead. We validate the effectiveness of the proposed method by extensive experiments on DeepLesion benchmark, a large-scale public dataset for universal lesion detection from computed tomography (CT). The proposed A3D consistently outperforms symmetric context fusion operators by considerable margins, and establishes a new \emph{state of the art} on DeepLesion. To facilitate open research, our code and model in PyTorch are available at https://github.com/M3DV/AlignShift.

Jiancheng Yang, Shixuan Gu, Donglai Wei et al.

Manual rib inspections in computed tomography (CT) scans are clinically critical but labor-intensive, as 24 ribs are typically elongated and oblique in 3D volumes. Automatic rib segmentation methods can speed up the process through rib measurement and visualization. However, prior arts mostly use in-house labeled datasets that are publicly unavailable and work on dense 3D volumes that are computationally inefficient. To address these issues, we develop a labeled rib segmentation benchmark, named \emph{RibSeg}, including 490 CT scans (11,719 individual ribs) from a public dataset. For ground truth generation, we used existing morphology-based algorithms and manually refined its results. Then, considering the sparsity of ribs in 3D volumes, we thresholded and sampled sparse voxels from the input and designed a point cloud-based baseline method for rib segmentation. The proposed method achieves state-of-the-art segmentation performance (Dice~$\approx95\%$) with significant efficiency ($10\sim40\times$ faster than prior arts). The RibSeg dataset, code, and model in PyTorch are available at https://github.com/M3DV/RibSeg.

Linguo Li, Minsi Wang, Bingbing Ni et al.

In this work, we propose a Cross-view Contrastive Learning framework for unsupervised 3D skeleton-based action Representation (CrosSCLR), by leveraging multi-view complementary supervision signal. CrosSCLR consists of both single-view contrastive learning (SkeletonCLR) and cross-view consistent knowledge mining (CVC-KM) modules, integrated in a collaborative learning manner. It is noted that CVC-KM works in such a way that high-confidence positive/negative samples and their distributions are exchanged among views according to their embedding similarity, ensuring cross-view consistency in terms of contrastive context, i.e., similar distributions. Extensive experiments show that CrosSCLR achieves remarkable action recognition results on NTU-60 and NTU-120 datasets under unsupervised settings, with observed higher-quality action representations. Our code is available at https://github.com/LinguoLi/CrosSCLR.

Jiancheng Yang, Rui Shi, Bingbing Ni

We present MedMNIST, a collection of 10 pre-processed medical open datasets. MedMNIST is standardized to perform classification tasks on lightweight 28x28 images, which requires no background knowledge. Covering the primary data modalities in medical image analysis, it is diverse on data scale (from 100 to 100,000) and tasks (binary/multi-class, ordinal regression and multi-label). MedMNIST could be used for educational purpose, rapid prototyping, multi-modal machine learning or AutoML in medical image analysis. Moreover, MedMNIST Classification Decathlon is designed to benchmark AutoML algorithms on all 10 datasets; We have compared several baseline methods, including open-source or commercial AutoML tools. The datasets, evaluation code and baseline methods for MedMNIST are publicly available at https://medmnist.github.io/.

Jiancheng Yang, Yangzhou Jiang, Xiaoyang Huang et al.

This paper addresses the challenging black-box adversarial attack problem, where only classification confidence of a victim model is available. Inspired by consistency of visual saliency between different vision models, a surrogate model is expected to improve the attack performance via transferability. By combining transferability-based and query-based black-box attack, we propose a surprisingly simple baseline approach (named SimBA++) using the surrogate model, which significantly outperforms several state-of-the-art methods. Moreover, to efficiently utilize the query feedback, we update the surrogate model in a novel learning scheme, named High-Order Gradient Approximation (HOGA). By constructing a high-order gradient computation graph, we update the surrogate model to approximate the victim model in both forward and backward pass. The SimBA++ and HOGA result in Learnable Black-Box Attack (LeBA), which surpasses previous state of the art by considerable margins: the proposed LeBA significantly reduces queries, while keeping higher attack success rates close to 100% in extensive ImageNet experiments, including attacking vision benchmarks and defensive models. Code is open source at https://github.com/TrustworthyDL/LeBA.

Jiancheng Yang, Yi He, Xiaoyang Huang et al.

This paper addresses a fundamental challenge in 3D medical image processing: how to deal with imaging thickness. For anisotropic medical volumes, there is a significant performance gap between thin-slice (mostly 1mm) and thick-slice (mostly 5mm) volumes. Prior arts tend to use 3D approaches for the thin-slice and 2D approaches for the thick-slice, respectively. We aim at a unified approach for both thin- and thick-slice medical volumes. Inspired by recent advances in video analysis, we propose AlignShift, a novel parameter-free operator to convert theoretically any 2D pretrained network into thickness-aware 3D network. Remarkably, the converted networks behave like 3D for the thin-slice, nevertheless degenerate to 2D for the thick-slice adaptively. The unified thickness-aware representation learning is achieved by shifting and fusing aligned "virtual slices" as per the input imaging thickness. Extensive experiments on public large-scale DeepLesion benchmark, consisting of 32K lesions for universal lesion detection, validate the effectiveness of our method, which outperforms previous state of the art by considerable margins without whistles and bells. More importantly, to our knowledge, this is the first method that bridges the performance gap between thin- and thick-slice volumes by a unified framework. To improve research reproducibility, our code in PyTorch is open source at https://github.com/M3DV/AlignShift.

Danli Shi, Weiyi Zhang, Xiaolan Chen et al.

Artificial intelligence (AI) is vital in ophthalmology, tackling tasks like diagnosis, classification, and visual question answering (VQA). However, existing AI models in this domain often require extensive annotation and are task-specific, limiting their clinical utility. While recent developments have brought about foundation models for ophthalmology, they are limited by the need to train separate weights for each imaging modality, preventing a comprehensive representation of multi-modal features. This highlights the need for versatile foundation models capable of handling various tasks and modalities in ophthalmology. To address this gap, we present EyeFound, a multimodal foundation model for ophthalmic images. Unlike existing models, EyeFound learns generalizable representations from unlabeled multimodal retinal images, enabling efficient model adaptation across multiple applications. Trained on 2.78 million images from 227 hospitals across 11 ophthalmic modalities, EyeFound facilitates generalist representations and diverse multimodal downstream tasks, even for detecting challenging rare diseases. It outperforms previous work RETFound in diagnosing eye diseases, predicting systemic disease incidents, and zero-shot multimodal VQA. EyeFound provides a generalizable solution to improve model performance and lessen the annotation burden on experts, facilitating widespread clinical AI applications for retinal imaging.

Jiancheng Yang, Rui Shi, Liang Jin et al. · harvard

Rib fractures are a common and potentially severe injury that can be challenging and labor-intensive to detect in CT scans. While there have been efforts to address this field, the lack of large-scale annotated datasets and evaluation benchmarks has hindered the development and validation of deep learning algorithms. To address this issue, the RibFrac Challenge was introduced, providing a benchmark dataset of over 5,000 rib fractures from 660 CT scans, with voxel-level instance mask annotations and diagnosis labels for four clinical categories (buckle, nondisplaced, displaced, or segmental). The challenge includes two tracks: a detection (instance segmentation) track evaluated by an FROC-style metric and a classification track evaluated by an F1-style metric. During the MICCAI 2020 challenge period, 243 results were evaluated, and seven teams were invited to participate in the challenge summary. The analysis revealed that several top rib fracture detection solutions achieved performance comparable or even better than human experts. Nevertheless, the current rib fracture classification solutions are hardly clinically applicable, which can be an interesting area in the future. As an active benchmark and research resource, the data and online evaluation of the RibFrac Challenge are available at the challenge website. As an independent contribution, we have also extended our previous internal baseline by incorporating recent advancements in large-scale pretrained networks and point-based rib segmentation techniques. The resulting FracNet+ demonstrates competitive performance in rib fracture detection, which lays a foundation for further research and development in AI-assisted rib fracture detection and diagnosis.

Weiyi Zhang, Jiancheng Yang, Ruoyu Chen et al.

Fundus fluorescein angiography (FFA) is crucial for diagnosing and monitoring retinal vascular issues but is limited by its invasive nature and restricted accessibility compared to color fundus (CF) imaging. Existing methods that convert CF images to FFA are confined to static image generation, missing the dynamic lesional changes. We introduce Fundus2Video, an autoregressive generative adversarial network (GAN) model that generates dynamic FFA videos from single CF images. Fundus2Video excels in video generation, achieving an FVD of 1497.12 and a PSNR of 11.77. Clinical experts have validated the fidelity of the generated videos. Additionally, the model's generator demonstrates remarkable downstream transferability across ten external public datasets, including blood vessel segmentation, retinal disease diagnosis, systemic disease prediction, and multimodal retrieval, showcasing impressive zero-shot and few-shot capabilities. These findings position Fundus2Video as a powerful, non-invasive alternative to FFA exams and a versatile retinal generative foundation model that captures both static and temporal retinal features, enabling the representation of complex inter-modality relationships.

Yihong Chen, Jiancheng Yang, Deniz Sayin Mercadier et al.

Reconstructing cardiac motion from CMR sequences is critical for diagnosis, prognosis, and intervention. Existing methods rely on complete CMR stacks to infer full heart motion, limiting their applicability during intervention when only sparse observations are available. We present TetHeart, the first end-to-end framework for unified 4D heart mesh recovery from both offline full-stack and intra-procedural sparse-slice observations. Our method leverages deformable tetrahedra to capture shape and motion in a coherent space shared across cardiac structures. Before a procedure, it initializes detailed, patient-specific heart meshes from high-quality full stacks, which can then be updated using whatever slices can be obtained in real-time, down to a single one during the procedure. TetHeart incorporates several key innovations: (i) an attentive slice-adaptive 2D-3D feature assembly mechanism that integrates information from arbitrary numbers of slices at any position; (ii) a distillation strategy to ensure accurate reconstruction under extreme sparsity; and (iii) a weakly supervised motion learning scheme requiring annotations only at keyframes, such as the end-diastolic and end-systolic phases. Trained and validated on three large public datasets and evaluated zero-shot on additional private interventional and public datasets without retraining, TetHeart achieves state-of-the-art accuracy and strong generalization in both pre- and intra-procedural settings.

Danli Shi, Bowen Liu, Zhen Tian et al.

Myopia, projected to affect 50% population globally by 2050, is a leading cause of vision loss. Eyes with pathological myopia exhibit distinctive shape distributions, which are closely linked to the progression of vision-threatening complications. Recent understanding of eye-shape-based biomarkers requires magnetic resonance imaging (MRI), however, it is costly and unrealistic in routine ophthalmology clinics. We present Fundus2Globe, the first AI framework that synthesizes patient-specific 3D eye globes from ubiquitous 2D color fundus photographs (CFPs) and routine metadata (axial length, spherical equivalent), bypassing MRI dependency. By integrating a 3D morphable eye model (encoding biomechanical shape priors) with a latent diffusion model, our approach achieves submillimeter accuracy in reconstructing posterior ocular anatomy efficiently. Fundus2Globe uniquely quantifies how vision-threatening lesions (e.g., staphylomas) in CFPs correlate with MRI-validated 3D shape abnormalities, enabling clinicians to simulate posterior segment changes in response to refractive shifts. External validation demonstrates its robust generation performance, ensuring fairness across underrepresented groups. By transforming 2D fundus imaging into 3D digital replicas of ocular structures, Fundus2Globe is a gateway for precision ophthalmology, laying the foundation for AI-driven, personalized myopia management.

Deniz Sayin Mercadier, Hieu Le, Yihong Chen et al.

Human organs are composed of interconnected substructures whose geometry and spatial relationships constrain one another. Yet, most deep-learning approaches treat these parts independently, producing anatomically implausible reconstructions. We introduce PrIntMesh, a template-based, topology-preserving framework that reconstructs organs as unified systems. Starting from a connected template, PrIntMesh jointly deforms all substructures to match patient-specific anatomy, while explicitly preserving internal boundaries and enforcing smooth, artifact-free surfaces. We demonstrate its effectiveness on the heart, hippocampus, and lungs, achieving high geometric accuracy, correct topology, and robust performance even with limited or noisy training data. Compared to voxel- and surface-based methods, PrIntMesh better reconstructs shared interfaces, maintains structural consistency, and provides a data-efficient solution suitable for clinical use.

Pusheng Xu, Xia Gong, Xiaolan Chen et al.

Purpose: To develop a bilingual multimodal visual question answering (VQA) benchmark for evaluating VLMs in ophthalmology. Methods: Ophthalmic image posts and associated captions published between January 1, 2016, and December 31, 2024, were collected from WeChat Official Accounts. Based on these captions, bilingual question-answer (QA) pairs in Chinese and English were generated using GPT-4o-mini. QA pairs were categorized into six subsets by question type and language: binary (Binary_CN, Binary_EN), single-choice (Single-choice_CN, Single-choice_EN), and open-ended (Open-ended_CN, Open-ended_EN). The benchmark was used to evaluate the performance of three VLMs: GPT-4o, Gemini 2.0 Flash, and Qwen2.5-VL-72B-Instruct. Results: The final OphthalWeChat dataset included 3,469 images and 30,120 QA pairs across 9 ophthalmic subspecialties, 548 conditions, 29 imaging modalities, and 68 modality combinations. Gemini 2.0 Flash achieved the highest overall accuracy (0.548), outperforming GPT-4o (0.522, P < 0.001) and Qwen2.5-VL-72B-Instruct (0.514, P < 0.001). It also led in both Chinese (0.546) and English subsets (0.550). Subset-specific performance showed Gemini 2.0 Flash excelled in Binary_CN (0.687), Single-choice_CN (0.666), and Single-choice_EN (0.646), while GPT-4o ranked highest in Binary_EN (0.717), Open-ended_CN (BLEU-1: 0.301; BERTScore: 0.382), and Open-ended_EN (BLEU-1: 0.183; BERTScore: 0.240). Conclusions: This study presents the first bilingual VQA benchmark for ophthalmology, distinguished by its real-world context and inclusion of multiple examinations per patient. The dataset reflects authentic clinical decision-making scenarios and enables quantitative evaluation of VLMs, supporting the development of accurate, specialized, and trustworthy AI systems for eye care.

Yue Wu, Yibo Guo, Yulong Yan et al.

We envision the "virtual eye" as a next-generation, AI-powered platform that uses interconnected foundation models to simulate the eye's intricate structure and biological function across all scales. Advances in AI, imaging, and multiomics provide a fertile ground for constructing a universal, high-fidelity digital replica of the human eye. This perspective traces the evolution from early mechanistic and rule-based models to contemporary AI-driven approaches, integrating in a unified model with multimodal, multiscale, dynamic predictive capabilities and embedded feedback mechanisms. We propose a development roadmap emphasizing the roles of large-scale multimodal datasets, generative AI, foundation models, agent-based architectures, and interactive interfaces. Despite challenges in interpretability, ethics, data processing and evaluation, the virtual eye holds the potential to revolutionize personalized ophthalmic care and accelerate research into ocular health and disease.

Leslie Gu, Jason Ken Adhinarta, Mikhail Bessmeltsev et al. · harvard

Accurately segmenting 3D curvilinear structures in medical imaging remains challenging due to their complex geometry and the scarcity of diverse, large-scale datasets for algorithm development and evaluation. In this paper, we use dendritic spine segmentation as a case study and address these challenges by introducing a novel Frenet--Serret Frame-based Decomposition, which decomposes 3D curvilinear structures into a globally \( C^2 \) continuous curve that captures the overall shape, and a cylindrical primitive that encodes local geometric properties. This approach leverages Frenet--Serret Frames and arc length parameterization to preserve essential geometric features while reducing representational complexity, facilitating data-efficient learning, improved segmentation accuracy, and generalization on 3D curvilinear structures. To rigorously evaluate our method, we introduce two datasets: CurviSeg, a synthetic dataset for 3D curvilinear structure segmentation that validates our method's key properties, and DenSpineEM, a benchmark for dendritic spine segmentation, which comprises 4,476 manually annotated spines from 70 dendrites across three public electron microscopy datasets, covering multiple brain regions and species. Our experiments on DenSpineEM demonstrate exceptional cross-region and cross-species generalization: models trained on the mouse somatosensory cortex subset achieve 91.9\% Dice, maintaining strong performance in zero-shot segmentation on both mouse visual cortex (94.1\% Dice) and human frontal lobe (81.8\% Dice) subsets. Moreover, we test the generalizability of our method on the IntrA dataset, where it achieves 77.08\% Dice (5.29\% higher than prior arts) on intracranial aneurysm segmentation. These findings demonstrate the potential of our approach for accurately analyzing complex curvilinear structures across diverse medical imaging fields.

Udaranga Wickramasinghe, Patrick M. Jensen, Mian Shah et al.

There are many approaches to weakly-supervised training of networks to segment 2D images. By contrast, existing approaches to segmenting volumetric images rely on full-supervision of a subset of 2D slices of the 3D volume. We propose an approach to volume segmentation that is truly weakly-supervised in the sense that we only need to provide a sparse set of 3D points on the surface of target objects instead of detailed 2D masks. We use the 3D points to deform a 3D template so that it roughly matches the target object outlines and we introduce an architecture that exploits the supervision it provides to train a network to find accurate boundaries. We evaluate our approach on Computed Tomography (CT), Magnetic Resonance Imagery (MRI) and Electron Microscopy (EM) image datasets and show that it substantially reduces the required amount of effort.

Jiancheng Yang, Jiajun Chen, Kaiming Kuang et al.

Predicting clinical outcome is remarkably important but challenging. Research efforts have been paid on seeking significant biomarkers associated with the therapy response or/and patient survival. However, these biomarkers are generally costly and invasive, and possibly dissatifactory for novel therapy. On the other hand, multi-modal, heterogeneous, unaligned temporal data is continuously generated in clinical practice. This paper aims at a unified deep learning approach to predict patient prognosis and therapy response, with easily accessible data, e.g., radiographics, laboratory and clinical information. Prior arts focus on modeling single data modality, or ignore the temporal changes. Importantly, the clinical time series is asynchronous in practice, i.e., recorded with irregular intervals. In this study, we formalize the prognosis modeling as a multi-modal asynchronous time series classification task, and propose a MIA-Prognosis framework with Measurement, Intervention and Assessment (MIA) information to predict therapy response, where a Simple Temporal Attention (SimTA) module is developed to process the asynchronous time series. Experiments on synthetic dataset validate the superiory of SimTA over standard RNN-based approaches. Furthermore, we experiment the proposed method on an in-house, retrospective dataset of real-world non-small cell lung cancer patients under anti-PD-1 immunotherapy. The proposed method achieves promising performance on predicting the immunotherapy response. Notably, our predictive model could further stratify low-risk and high-risk patients in terms of long-term survival.