BackgroundDifferent Natural Language Processing (NLP) techniques have demonstrated promising results for data extraction from radiological reports. Both traditional rule-based methods like regular expressions (Regex) and modern Large Language Models (LLMs) can extract structured information. However, comparison between these approaches for extraction of specific radiological data elements has not been widely conducted. MethodsWe compared accuracy and processing time between Regex and LLM-based approaches for extracting BI-RADS scores from 7,764 radiology reports (mammography, ultrasound, MRI, and biopsy). We developed a rule-based algorithm using Regex patterns and implemented an LLM-based extraction using the Rombos-LLM-V2.6-Qwen-14b model. A ground truth dataset of 199 manually classified reports was used for evaluation. ResultsThere was no statistically significant difference in the accuracy in extracting BI-RADS scores between Regex and an LLM-based method (accuracy of 89.20% for Regex versus 87.69% for the LLM-based method; p=0.56). Compared to the LLM-based method, Regex processing was more efficient, completing the task 28,120 times faster (0.06 seconds vs. 1687.20 seconds). Further analysis revealed LLMs favored common classifications (particularly BI-RADS value of 2) while Regex more frequently returned "unclear" values. We also could confirm in our sample an already known laterality bias for breast cancer (BI-RADS 6) and detected a slight laterality skew for suspected breast cancer (BI-RADS 5) as well. ConclusionFor structured, standardized data like BI-RADS, traditional NLP techniques seem to be superior, though future work should explore hybrid approaches combining Regex precision for standardized elements with LLM contextual understanding for more complex information extraction tasks.

The escalating demand for medical image interpretation underscores the critical need for advanced artificial intelligence solutions to enhance the efficiency and accuracy of radiological diagnoses. This paper introduces CXR-PathFinder, a novel Large Language Model (LLM)-centric foundation model specifically engineered for automated chest X-ray (CXR) report generation. We propose a unique training paradigm, Clinician-Guided Adversarial Fine-Tuning (CGAFT), which meticulously integrates expert clinical feedback into an adversarial learning framework to mitigate factual inconsistencies and improve diagnostic precision. Complementing this, our Knowledge Graph Augmentation Module (KGAM) acts as an inference-time safeguard, dynamically verifying generated medical statements against authoritative knowledge bases to minimize hallucinations and ensure standardized terminology. Leveraging a comprehensive dataset of millions of paired CXR images and expert reports, our experiments demonstrate that CXR-PathFinder significantly outperforms existing state-of-the-art medical vision-language models across various quantitative metrics, including clinical accuracy (Macro F1 (14): 46.5, Micro F1 (14): 59.5). Furthermore, blinded human evaluation by board-certified radiologists confirms CXR-PathFinder's superior clinical utility, completeness, and accuracy, establishing its potential as a reliable and efficient aid for radiological practice. The developed method effectively balances high diagnostic fidelity with computational efficiency, providing a robust solution for automated medical report generation.

Medical professionals, especially those in training, often depend on visual reference materials to support an accurate diagnosis and develop pattern recognition skills. However, existing resources may lack the diversity and accessibility needed for broad and effective clinical learning. This paper presents a system designed to generate realistic medical images from textual descriptions and validate their accuracy through a classification model. A pretrained stable diffusion model was fine-tuned using Low-Rank Adaptation (LoRA) on the PathMNIST dataset, consisting of nine colorectal histopathology tissue types. The generative model was trained multiple times using different training parameter configurations, guided by domain-specific prompts to capture meaningful features. To ensure quality control, a ResNet-18 classification model was trained on the same dataset, achieving 99.76% accuracy in detecting the correct label of a colorectal histopathological medical image. Generated images were then filtered using the trained classifier and an iterative process, where inaccurate outputs were discarded and regenerated until they were correctly classified. The highest performing version of the generative model from experimentation achieved an F1 score of 0.6727, with precision and recall scores of 0.6817 and 0.7111, respectively. Some types of tissue, such as adipose tissue and lymphocytes, reached perfect classification scores, while others proved more challenging due to structural complexity. The self-validating approach created demonstrates a reliable method for synthesizing domain-specific medical images because of high accuracy in both the generation and classification portions of the system, with potential applications in both diagnostic support and clinical education. Future work includes improving prompt-specific accuracy and extending the system to other areas of medical imaging.

Multimodal MR-US registration is critical for prostate cancer diagnosis. However, this task remains challenging due to significant modality discrepancies. Existing methods often fail to align critical boundaries while being overly sensitive to irrelevant details. To address this, we propose an anatomically coherent modality translation (ACMT) network based on a hierarchical feature disentanglement design. We leverage shallow-layer features for texture consistency and deep-layer features for boundary preservation. Unlike conventional modality translation methods that convert one modality into another, our ACMT introduces the customized design of an intermediate pseudo modality. Both MR and US images are translated toward this intermediate domain, effectively addressing the bottlenecks faced by traditional translation methods in the downstream registration task. Experiments demonstrate that our method mitigates modality-specific discrepancies while preserving crucial anatomical boundaries for accurate registration. Quantitative evaluations show superior modality similarity compared to state-of-the-art modality translation methods. Furthermore, downstream registration experiments confirm that our translated images achieve the best alignment performance, highlighting the robustness of our framework for multi-modal prostate image registration.

Purpose: Accurate segmentation of clinical target volumes (CTV) and organs-at-risk is crucial for optimizing gynecologic brachytherapy (GYN-BT) treatment planning. However, anatomical variability, low soft-tissue contrast in CT imaging, and limited annotated datasets pose significant challenges. This study presents GynBTNet, a novel multi-stage learning framework designed to enhance segmentation performance through self-supervised pretraining and hierarchical fine-tuning strategies. Methods: GynBTNet employs a three-stage training strategy: (1) self-supervised pretraining on large-scale CT datasets using sparse submanifold convolution to capture robust anatomical representations, (2) supervised fine-tuning on a comprehensive multi-organ segmentation dataset to refine feature extraction, and (3) task-specific fine-tuning on a dedicated GYN-BT dataset to optimize segmentation performance for clinical applications. The model was evaluated against state-of-the-art methods using the Dice Similarity Coefficient (DSC), 95th percentile Hausdorff Distance (HD95), and Average Surface Distance (ASD). Results: Our GynBTNet achieved superior segmentation performance, significantly outperforming nnU-Net and Swin-UNETR. Notably, it yielded a DSC of 0.837 +/- 0.068 for CTV, 0.940 +/- 0.052 for the bladder, 0.842 +/- 0.070 for the rectum, and 0.871 +/- 0.047 for the uterus, with reduced HD95 and ASD compared to baseline models. Self-supervised pretraining led to consistent performance improvements, particularly for structures with complex boundaries. However, segmentation of the sigmoid colon remained challenging, likely due to anatomical ambiguities and inter-patient variability. Statistical significance analysis confirmed that GynBTNet's improvements were significant compared to baseline models.

The accelerating development of general medical artificial intelligence (GMAI), powered by multimodal large language models (MLLMs), offers transformative potential for addressing persistent healthcare challenges, including workforce deficits and escalating costs. The parallel development of systematic evaluation benchmarks emerges as a critical imperative to enable performance assessment and provide technological guidance. Meanwhile, as an invaluable knowledge source, the potential of medical textbooks for benchmark development remains underexploited. Here, we present MedBookVQA, a systematic and comprehensive multimodal benchmark derived from open-access medical textbooks. To curate this benchmark, we propose a standardized pipeline for automated extraction of medical figures while contextually aligning them with corresponding medical narratives. Based on this curated data, we generate 5,000 clinically relevant questions spanning modality recognition, disease classification, anatomical identification, symptom diagnosis, and surgical procedures. A multi-tier annotation system categorizes queries through hierarchical taxonomies encompassing medical imaging modalities (42 categories), body anatomies (125 structures), and clinical specialties (31 departments), enabling nuanced analysis across medical subdomains. We evaluate a wide array of MLLMs, including proprietary, open-sourced, medical, and reasoning models, revealing significant performance disparities across task types and model categories. Our findings highlight critical capability gaps in current GMAI systems while establishing textbook-derived multimodal benchmarks as essential evaluation tools. MedBookVQA establishes textbook-derived benchmarking as a critical paradigm for advancing clinical AI, exposing limitations in GMAI systems while providing anatomically structured performance metrics across specialties.

Cardiac magnetic resonance (CMR) is a key investigation in clinical cardiovascular medicine and has been used extensively in population research. However, extracting clinically important measurements such as ejection fraction for diagnosing cardiovascular diseases remains time-consuming and subjective. We developed CineMA, a foundation AI model automating these tasks with limited labels. CineMA is a self-supervised autoencoder model trained on 74,916 cine CMR studies to reconstruct images from masked inputs. After fine-tuning, it was evaluated across eight datasets on 23 tasks from four categories: ventricle and myocardium segmentation, left and right ventricle ejection fraction calculation, disease detection and classification, and landmark localisation. CineMA is the first foundation model for cine CMR to match or outperform convolutional neural networks (CNNs). CineMA demonstrated greater label efficiency than CNNs, achieving comparable or better performance with fewer annotations. This reduces the burden of clinician labelling and supports replacing task-specific training with fine-tuning foundation models in future cardiac imaging applications. Models and code for pre-training and fine-tuning are available at https://github.com/mathpluscode/CineMA, democratising access to high-performance models that otherwise require substantial computational resources, promoting reproducibility and accelerating clinical translation.

Detecting breast cancer early is of the utmost importance to effectively treat the millions of women afflicted by breast cancer worldwide every year. Although mammography is the primary imaging modality for screening breast cancer, there is an increasing interest in adding magnetic resonance imaging (MRI) to screening programmes, particularly for women at high risk. Recent guidelines by the European Society of Breast Imaging (EUSOBI) recommended breast MRI as a supplemental screening tool for women with dense breast tissue. However, acquiring and reading MRI scans requires significantly more time from expert radiologists. This highlights the need to develop new automated methods to detect cancer accurately using MRI and Artificial Intelligence (AI), which have the potential to support radiologists in breast MRI interpretation and classification and help detect cancer earlier. For this reason, the ODELIA consortium has made this multi-centre dataset publicly available to assist in developing AI tools for the detection of breast cancer on MRI.

The diagnosis of prostate cancer increasingly depends on multimodal imaging, particularly magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). However, accurate registration between these modalities remains a fundamental challenge due to the differences in dimensionality and anatomical representations. In this work, we present a novel framework that addresses these challenges through a two-stage process: TRUS 3D reconstruction followed by cross-modal registration. Unlike existing TRUS 3D reconstruction methods that rely heavily on external probe tracking information, we propose a totally probe-location-independent approach that leverages the natural correlation between sagittal and transverse TRUS views. With the help of our clustering-based feature matching method, we enable the spatial localization of 2D frames without any additional probe tracking information. For the registration stage, we introduce an unsupervised diffusion-based framework guided by modality translation. Unlike existing methods that translate one modality into another, we map both MR and US into a pseudo intermediate modality. This design enables us to customize it to retain only registration-critical features, greatly easing registration. To further enhance anatomical alignment, we incorporate an anatomy-aware registration strategy that prioritizes internal structural coherence while adaptively reducing the influence of boundary inconsistencies. Extensive validation demonstrates that our approach outperforms state-of-the-art methods by achieving superior registration accuracy with physically realistic deformations in a completely unsupervised fashion.

Clinical decision-making routinely demands reasoning over heterogeneous data, yet existing multimodal language models (MLLMs) remain largely vision-centric and fail to generalize across clinical specialties. To bridge this gap, we introduce QoQ-Med-7B/32B, the first open generalist clinical foundation model that jointly reasons across medical images, time-series signals, and text reports. QoQ-Med is trained with Domain-aware Relative Policy Optimization (DRPO), a novel reinforcement-learning objective that hierarchically scales normalized rewards according to domain rarity and modality difficulty, mitigating performance imbalance caused by skewed clinical data distributions. Trained on 2.61 million instruction tuning pairs spanning 9 clinical domains, we show that DRPO training boosts diagnostic performance by 43% in macro-F1 on average across all visual domains as compared to other critic-free training methods like GRPO. Furthermore, with QoQ-Med trained on intensive segmentation data, it is able to highlight salient regions related to the diagnosis, with an IoU 10x higher than open models while reaching the performance of OpenAI o4-mini. To foster reproducibility and downstream research, we release (i) the full model weights, (ii) the modular training pipeline, and (iii) all intermediate reasoning traces at https://github.com/DDVD233/QoQ_Med.