Huangxuan Zhao

Xianhao Zhou, Jianghao Wu, Ku Zhao et al.

Generating synthetic CT images from CBCT or MRI has a potential for efficient radiation dose planning and adaptive radiotherapy. However, existing CNN-based models lack global semantic understanding, while Transformers often overfit small medical datasets due to high model capacity and weak inductive bias. To address these limitations, we propose a DINOv3-Guided Cross Fusion (DGCF) framework that integrates a frozen self-supervised DINOv3 Transformer with a trainable CNN encoder-decoder. It hierarchically fuses global representation of Transformer and local features of CNN via a learnable cross fusion module, achieving balanced local appearance and contextual representation. Furthermore, we introduce a Multi-Level DINOv3 Perceptual (MLDP) loss that encourages semantic similarity between synthetic CT and the ground truth in DINOv3's feature space. Experiments on the SynthRAD2023 pelvic dataset demonstrate that DGCF achieved state-of-the-art performance in terms of MS-SSIM, PSNR and segmentation-based metrics on both MRI$\rightarrow$CT and CBCT$\rightarrow$CT translation tasks. To the best of our knowledge, this is the first work to employ DINOv3 representations for medical image translation, highlighting the potential of self-supervised Transformer guidance for semantic-aware CT synthesis. The code is available at https://github.com/HiLab-git/DGCF.

Ruiheng Zhang, Jingfeng Yao, Huangxuan Zhao et al.

Despite recent progress, medical foundation models still struggle to unify visual understanding and generation, as these tasks have inherently conflicting goals: semantic abstraction versus pixel-level reconstruction. Existing approaches, typically based on parameter-shared autoregressive architectures, frequently lead to compromised performance in one or both tasks. To address this, we present UniX, a next-generation unified medical foundation model for chest X-ray understanding and generation. UniX decouples the two tasks into an autoregressive branch for understanding and a diffusion branch for high-fidelity generation. Crucially, a cross-modal self-attention mechanism is introduced to dynamically guide the generation process with understanding features. Coupled with a rigorous data cleaning pipeline and a multi-stage training strategy, this architecture enables synergistic collaboration between tasks while leveraging the strengths of diffusion models for superior generation. On two representative benchmarks, UniX achieves a 46.1% improvement in understanding performance (Micro-F1) and a 24.2% gain in generation quality (FD-RadDino), using only a quarter of the parameters of LLM-CXR. By achieving performance on par with task-specific models, our work establishes a scalable paradigm for synergistic medical image understanding and generation. Codes and models are available at https://github.com/ZrH42/UniX.

Ziyang Xu, Huangxuan Zhao, Ziwei Cui et al.

Artificial intelligence has become a crucial tool for medical image analysis. As an advanced cerebral angiography technique, Digital Subtraction Angiography (DSA) poses a challenge where the radiation dose to humans is proportional to the image count. By reducing images and using AI interpolation instead, the radiation can be cut significantly. However, DSA images present more complex motion and structural features than natural scenes, making interpolation more challenging. We propose MoSt-DSA, the first work that uses deep learning for DSA frame interpolation. Unlike natural scene Video Frame Interpolation (VFI) methods that extract unclear or coarse-grained features, we devise a general module that models motion and structural context interactions between frames in an efficient full convolution manner by adjusting optimal context range and transforming contexts into linear functions. Benefiting from this, MoSt-DSA is also the first method that directly achieves any number of interpolations at any time steps with just one forward pass during both training and testing. We conduct extensive comparisons with 7 representative VFI models for interpolating 1 to 3 frames, MoSt-DSA demonstrates robust results across 470 DSA image sequences (each typically 152 images), with average SSIM over 0.93, average PSNR over 38 (standard deviations of less than 0.030 and 3.6, respectively), comprehensively achieving state-of-the-art performance in accuracy, speed, visual effect, and memory usage. Our code is available at https://github.com/ZyoungXu/MoSt-DSA.

Ziyi Zhang, Li Shen, Deheng Ye et al.

Text-to-multiview (T2MV) diffusion models have shown great promise in generating multiple views of a scene from a single text prompt. While few-step backbones enable real-time T2MV generation, they often compromise key aspects of generation quality, such as per-view fidelity and cross-view consistency. Reinforcement learning (RL) finetuning offers a potential solution, yet existing approaches designed for single-image diffusion do not readily extend to the few-step T2MV setting, as they neglect cross-view coordination and suffer from weak learning signals in few-step regimes. To address this, we propose MVC-ZigAL, a tailored RL finetuning framework for few-step T2MV diffusion models. Specifically, its core insights are: (1) a new MDP formulation that jointly models all generated views and assesses their collective quality via a joint-view reward; (2) a novel advantage learning strategy that exploits the performance gains of a self-refinement sampling scheme over standard sampling, yielding stronger learning signals for effective RL finetuning; and (3) a unified RL framework that extends advantage learning with a Lagrangian dual formulation for multiview-constrained optimization, balancing single-view and joint-view objectives through adaptive primal-dual updates under a self-paced threshold curriculum that harmonizes exploration and constraint enforcement. Collectively, these designs enable robust and balanced RL finetuning for few-step T2MV diffusion models, yielding substantial gains in both per-view fidelity and cross-view consistency. Code is available at https://github.com/ZiyiZhang27/MVC-ZigAL.

Yaowei Bai, Ruiheng Zhang, Yu Lei et al.

A global shortage of radiologists has been exacerbated by the significant volume of chest X-ray workloads, particularly in primary care. Although multimodal large language models show promise, existing evaluations predominantly rely on automated metrics or retrospective analyses, lacking rigorous prospective clinical validation. Janus-Pro-CXR (1B), a chest X-ray interpretation system based on DeepSeek Janus-Pro model, was developed and rigorously validated through a multicenter prospective trial (NCT07117266). Our system outperforms state-of-the-art X-ray report generation models in automated report generation, surpassing even larger-scale models including ChatGPT 4o (200B parameters), while demonstrating reliable detection of six clinically critical radiographic findings. Retrospective evaluation confirms significantly higher report accuracy than Janus-Pro and ChatGPT 4o. In prospective clinical deployment, AI assistance significantly improved report quality scores, reduced interpretation time by 18.3% (P < 0.001), and was preferred by a majority of experts in 54.3% of cases. Through lightweight architecture and domain-specific optimization, Janus-Pro-CXR improves diagnostic reliability and workflow efficiency, particularly in resource-constrained settings. The model architecture and implementation framework will be open-sourced to facilitate the clinical translation of AI-assisted radiology solutions.

Zhenghong Zhou, Huangxuan Zhao, Jiemin Fang et al.

Four-dimensional Digital Subtraction Angiography (4D DSA) plays a critical role in the diagnosis of many medical diseases, such as Arteriovenous Malformations (AVM) and Arteriovenous Fistulas (AVF). Despite its significant application value, the reconstruction of 4D DSA demands numerous views to effectively model the intricate vessels and radiocontrast flow, thereby implying a significant radiation dose. To address this high radiation issue, we propose a Time-aware Attenuation Voxel (TiAVox) approach for sparse-view 4D DSA reconstruction, which paves the way for high-quality 4D imaging. Additionally, 2D and 3D DSA imaging results can be generated from the reconstructed 4D DSA images. TiAVox introduces 4D attenuation voxel grids, which reflect attenuation properties from both spatial and temporal dimensions. It is optimized by minimizing discrepancies between the rendered images and sparse 2D DSA images. Without any neural network involved, TiAVox enjoys specific physical interpretability. The parameters of each learnable voxel represent the attenuation coefficients. We validated the TiAVox approach on both clinical and simulated datasets, achieving a 31.23 Peak Signal-to-Noise Ratio (PSNR) for novel view synthesis using only 30 views on the clinically sourced dataset, whereas traditional Feldkamp-Davis-Kress methods required 133 views. Similarly, with merely 10 views from the synthetic dataset, TiAVox yielded a PSNR of 34.32 for novel view synthesis and 41.40 for 3D reconstruction. We also executed ablation studies to corroborate the essential components of TiAVox. The code will be publically available.

Haoshen Wang, Lei Chen, Wei-Hua Zhang et al.

Cone beam computed tomography (CBCT)-guided puncture has become an established approach for diagnosing and treating early- to mid-stage thoracic tumours, yet the associated radiation exposure substantially elevates the risk of secondary malignancies. Although multiple low-dose CBCT strategies have been introduced, none have undergone validation using large-scale multicenter retrospective datasets, and prospective clinical evaluation remains lacking. Here, we propose DeepPriorCBCT - a three-stage deep learning framework that achieves diagnostic-grade reconstruction using only one-sixth of the conventional radiation dose. 4102 patients with 8675 CBCT scans from 12 centers were included to develop and validate DeepPriorCBCT. Additionally, a prospective cross-over trial (Registry number: NCT07035977) which recruited 138 patients scheduled for percutaneous thoracic puncture was conducted to assess the model's clinical applicability. Assessment by 11 physicians confirmed that reconstructed images were indistinguishable from original scans. Moreover, diagnostic performance and overall image quality were comparable to those generated by standard reconstruction algorithms. In the prospective trial, five radiologists reported no significant differences in image quality or lesion assessment between DeepPriorCBCT and the clinical standard (all P>0.05). Likewise, 25 interventionalists expressed no preference between model-based and full-sampling images for surgical guidance (Kappa<0.2). Radiation exposure with DeepPriorCBCT was reduced to approximately one-sixth of that with the conventional approach, and collectively, the findings confirm that it enables high-quality CBCT reconstruction under sparse sampling conditions while markedly decreasing intraoperative radiation risk.

Gaoren Lin, Huangxuan Zhao, Yuan Xiong et al.

Text-guided medical segmentation enhances segmentation accuracy by utilizing clinical reports as auxiliary information. However, existing methods typically rely on unaligned image and text encoders, which necessitate complex interaction modules for multimodal fusion. While CLIP provides a pre-aligned multimodal feature space, its direct application to medical imaging is limited by three main issues: insufficient preservation of fine-grained anatomical structures, inadequate modeling of complex clinical descriptions, and domain-specific semantic misalignment. To tackle these challenges, we propose TGC-Net, a CLIP-based framework focusing on parameter-efficient, task-specific adaptations. Specifically, it incorporates a Semantic-Structural Synergy Encoder (SSE) that augments CLIP's ViT with a CNN branch for multi-scale structural refinement, a Domain-Augmented Text Encoder (DATE) that injects large-language-model-derived medical knowledge, and a Vision-Language Calibration Module (VLCM) that refines cross-modal correspondence in a unified feature space. Experiments on five datasets across chest X-ray and thoracic CT modalities demonstrate that TGC-Net achieves state-of-the-art performance with substantially fewer trainable parameters, including notable Dice gains on challenging benchmarks.

Jingfeng Yao, Xinggang Wang, Yuehao Song et al.

The diagnosis and treatment of chest diseases play a crucial role in maintaining human health. X-ray examination has become the most common clinical examination means due to its efficiency and cost-effectiveness. Artificial intelligence analysis methods for chest X-ray images are limited by insufficient annotation data and varying levels of annotation, resulting in weak generalization ability and difficulty in clinical dissemination. Here we present EVA-X, an innovative foundational model based on X-ray images with broad applicability to various chest disease detection tasks. EVA-X is the first X-ray image based self-supervised learning method capable of capturing both semantic and geometric information from unlabeled images for universal X-ray image representation. Through extensive experimentation, EVA-X has demonstrated exceptional performance in chest disease analysis and localization, becoming the first model capable of spanning over 20 different chest diseases and achieving leading results in over 11 different detection tasks in the medical field. Additionally, EVA-X significantly reduces the burden of data annotation in the medical AI field, showcasing strong potential in the domain of few-shot learning. The emergence of EVA-X will greatly propel the development and application of foundational medical models, bringing about revolutionary changes in future medical research and clinical practice. Our codes and models are available at: https://github.com/hustvl/EVA-X.

Shuai Zhang, Huangxuan Zhao, Zhenghong Zhou et al.

Four-dimensional Digital Subtraction Angiography (4D DSA) is a medical imaging technique that provides a series of 2D images captured at different stages and angles during the process of contrast agent filling blood vessels. It plays a significant role in the diagnosis of cerebrovascular diseases. Improving the rendering quality and speed under sparse sampling is important for observing the status and location of lesions. The current methods exhibit inadequate rendering quality in sparse views and suffer from slow rendering speed. To overcome these limitations, we propose TOGS, a Gaussian splatting method with opacity offset over time, which can effectively improve the rendering quality and speed of 4D DSA. We introduce an opacity offset table for each Gaussian to model the opacity offsets of the Gaussian, using these opacity-varying Gaussians to model the temporal variations in the radiance of the contrast agent. By interpolating the opacity offset table, the opacity variation of the Gaussian at different time points can be determined. This enables us to render the 2D DSA image at that specific moment. Additionally, we introduced a Smooth loss term in the loss function to mitigate overfitting issues that may arise in the model when dealing with sparse view scenarios. During the training phase, we randomly prune Gaussians, thereby reducing the storage overhead of the model. The experimental results demonstrate that compared to previous methods, this model achieves state-of-the-art render quality under the same number of training views. Additionally, it enables real-time rendering while maintaining low storage overhead. The code is available at https://github.com/hustvl/TOGS.

Xianhao Zhou, Jianghao Wu, Huangxuan Zhao et al.

Generating synthetic Computed Tomography (CT) images from Cone Beam Computed Tomography (CBCT) is desirable for improving the image quality of CBCT. Existing synthetic CT (sCT) generation methods using Convolutional Neural Networks (CNN) and Transformers often face difficulties in effectively capturing both global and local features and contrasts for high-quality sCT generation. In this work, we propose a Global-Local Feature and Contrast learning (GLFC) framework for sCT generation. First, a Mamba-Enhanced UNet (MEUNet) is introduced by integrating Mamba blocks into the skip connections of a high-resolution UNet for effective global and local feature learning. Second, we propose a Multiple Contrast Loss (MCL) that calculates synthetic loss at different intensity windows to improve quality for both soft tissues and bone regions. Experiments on the SynthRAD2023 dataset demonstrate that GLFC improved the SSIM of sCT from 77.91% to 91.50% compared with the original CBCT, and significantly outperformed several existing methods for sCT generation. The code is available at https://github.com/HiLab-git/GLFC

Ziyang Xu, Huangxuan Zhao, Wenyu Liu et al.

The rapid and accurate direct multi-frame interpolation method for Digital Subtraction Angiography (DSA) images is crucial for reducing radiation and providing real-time assistance to physicians for precise diagnostics and treatment. DSA images contain complex vascular structures and various motions. Applying natural scene Video Frame Interpolation (VFI) methods results in motion artifacts, structural dissipation, and blurriness. Recently, MoSt-DSA has specifically addressed these issues for the first time and achieved SOTA results. However, MoSt-DSA's focus on real-time performance leads to insufficient suppression of high-frequency noise and incomplete filtering of low-frequency noise in the generated images. To address these issues within the same computational time scale, we propose GaraMoSt. Specifically, we optimize the network pipeline with a parallel design and propose a module named MG-MSFE. MG-MSFE extracts frame-relative motion and structural features at various granularities in a fully convolutional parallel manner and supports independent, flexible adjustment of context-aware granularity at different scales, thus enhancing computational efficiency and accuracy. Extensive experiments demonstrate that GaraMoSt achieves the SOTA performance in accuracy, robustness, visual effects, and noise suppression, comprehensively surpassing MoSt-DSA and other natural scene VFI methods. The code and models are available at https://github.com/ZyoungXu/GaraMoSt.

Zhentao Liu, Huangxuan Zhao, Wenhui Qin et al.

Digital Subtraction Angiography (DSA) is one of the gold standards in vascular disease diagnosing. With the help of contrast agent, time-resolved 2D DSA images deliver comprehensive insights into blood flow information and can be utilized to reconstruct 3D vessel structures. Current commercial DSA systems typically demand hundreds of scanning views to perform reconstruction, resulting in substantial radiation exposure. However, sparse-view DSA reconstruction, aimed at reducing radiation dosage, is still underexplored in the research community. The dynamic blood flow and insufficient input of sparse-view DSA images present significant challenges to the 3D vessel reconstruction task. In this study, we propose to use a time-agnostic vessel probability field to solve this problem effectively. Our approach, termed as vessel probability guided attenuation learning, represents the DSA imaging as a complementary weighted combination of static and dynamic attenuation fields, with the weights derived from the vessel probability field. Functioning as a dynamic mask, vessel probability provides proper gradients for both static and dynamic fields adaptive to different scene types. This mechanism facilitates a self-supervised decomposition between static backgrounds and dynamic contrast agent flow, and significantly improves the reconstruction quality. Our model is trained by minimizing the disparity between synthesized projections and real captured DSA images. We further employ two training strategies to improve our reconstruction quality: (1) coarse-to-fine progressive training to achieve better geometry and (2) temporal perturbed rendering loss to enforce temporal consistency. Experimental results have demonstrated superior quality on both 3D vessel reconstruction and 2D view synthesis.

Zhentao Liu, Ruyi Zha, Huangxuan Zhao et al.

Reconstructing 3D vessel structures from sparse-view dynamic digital subtraction angiography (DSA) images enables accurate medical assessment while reducing radiation exposure. Existing methods often produce suboptimal results or require excessive computation time. In this work, we propose 4D radiative Gaussian splatting (4DRGS) to achieve high-quality reconstruction efficiently. In detail, we represent the vessels with 4D radiative Gaussian kernels. Each kernel has time-invariant geometry parameters, including position, rotation, and scale, to model static vessel structures. The time-dependent central attenuation of each kernel is predicted from a compact neural network to capture the temporal varying response of contrast agent flow. We splat these Gaussian kernels to synthesize DSA images via X-ray rasterization and optimize the model with real captured ones. The final 3D vessel volume is voxelized from the well-trained kernels. Moreover, we introduce accumulated attenuation pruning and bounded scaling activation to improve reconstruction quality. Extensive experiments on real-world patient data demonstrate that 4DRGS achieves impressive results in 5 minutes training, which is 32x faster than the state-of-the-art method. This underscores the potential of 4DRGS for real-world clinics.

Shiyu Zhang, Zhicong Wu, Huangxuan Zhao et al.

Digital subtraction angiography (DSA) is a key imaging technique for the auxiliary diagnosis and treatment of cerebrovascular diseases. Recent advancements in gaussian splatting and dynamic neural representations have enabled robust 3D vessel reconstruction from sparse dynamic inputs. However, these methods are fundamentally constrained by the resolution of input projections, where performing naive upsampling to enhance rendering resolution inevitably results in severe blurring and aliasing artifacts. Such lack of super-resolution capability prevents the reconstructed 4D models from recovering fine-grained vascular details and intricate branching structures, which restricts their application in precision diagnosis and treatment. To solve this problem, this paper proposes DSA-SRGS, the first super-resolution gaussian splatting framework for dynamic sparse-view DSA reconstruction. Specifically, we introduce a Multi-Fidelity Texture Learning Module that integrates high-quality priors from a fine-tuned DSA-specific super-resolution model, into the 4D reconstruction optimization. To mitigate potential hallucination artifacts from pseudo-labels, this module employs a Confidence-Aware Strategy to adaptively weight supervision signals between the original low-resolution projections and the generated high-resolution pseudo-labels. Furthermore, we develop Radiative Sub-Pixel Densification, an adaptive strategy that leverages gradient accumulation from high-resolution sub-pixel sampling to refine the 4D radiative gaussian kernels. Extensive experiments on two clinical DSA datasets demonstrate that DSA-SRGS significantly outperforms state-of-the-art methods in both quantitative metrics and qualitative visual fidelity.

Xiao He, Huangxuan Zhao, Guojia Wan et al.

Recent medical vision-language models have shown promise on tasks such as VQA, report generation, and anomaly detection. However, most are adapted to structured adult imaging and underperform in fetal ultrasound, which poses challenges of multi-view image reasoning, numerous diseases, and image diversity. To bridge this gap, we introduce FetalMind, a medical AI system tailored to fetal ultrasound for both report generation and diagnosis. Guided by clinical workflow, we propose Salient Epistemic Disentanglement (SED), which injects an expert-curated bipartite graph into the model to decouple view-disease associations and to steer preference selection along clinically faithful steps via reinforcement learning. This design mitigates variability across diseases and heterogeneity across views, reducing learning bottlenecks while aligning the model's inference with obstetric practice. To train FetalMind at scale, we curate FetalSigma-1M dataset, the first large-scale fetal ultrasound report corpus, comprising 20K reports from twelve medical centers, addressing the scarcity of domain data. Extensive experiments show that FetalMind outperforms open- and closed-source baselines across all gestational stages, achieving +14% average gains and +61.2% higher accuracy on critical conditions while remaining efficient, stable, and scalable. Project Page: https://hexiao0275.github.io/FetalMind.