Cone Beam Computed Tomography (CBCT) is widely used in medical imaging. However, the limited number and intensity of X-ray projections make reconstruction an ill-posed problem with severe artifacts. NeRF-based methods have achieved great success in this task. However, they suffer from a local-global training mismatch between their two key components: the hash encoder and the neural network. Specifically, in each training step, only a subset of the hash encoder's parameters is used (local sparse), whereas all parameters in the neural network participate (global dense). Consequently, hash features generated in each step are highly misaligned, as they come from different subsets of the hash encoder. These misalignments from different training steps are then fed into the neural network, causing repeated inconsistent global updates in training, which leads to unstable training, slower convergence, and degraded reconstruction quality. Aiming to alleviate the impact of this local-global optimization mismatch, we introduce a Normalized Hash Encoder, which enhances feature consistency and mitigates the mismatch. Additionally, we propose a Mapping Consistency Initialization(MCI) strategy that initializes the neural network before training by leveraging the global mapping property from a well-trained model. The initialized neural network exhibits improved stability during early training, enabling faster convergence and enhanced reconstruction performance. Our method is simple yet effective, requiring only a few lines of code while substantially improving training efficiency on 128 CT cases collected from 4 different datasets, covering 7 distinct anatomical regions.

Understanding medical ultrasound imaging remains a long-standing challenge due to significant visual variability caused by differences in imaging and acquisition parameters. Recent advancements in large language models (LLMs) have been used to automatically generate terminology-rich summaries orientated to clinicians with sufficient physiological knowledge. Nevertheless, the increasing demand for improved ultrasound interpretability and basic scanning guidance among non-expert users, e.g., in point-of-care settings, has not yet been explored. In this study, we first introduce the scene graph (SG) for ultrasound images to explain image content to ordinary and provide guidance for ultrasound scanning. The ultrasound SG is first computed using a transformer-based one-stage method, eliminating the need for explicit object detection. To generate a graspable image explanation for ordinary, the user query is then used to further refine the abstract SG representation through LLMs. Additionally, the predicted SG is explored for its potential in guiding ultrasound scanning toward missing anatomies within the current imaging view, assisting ordinary users in achieving more standardized and complete anatomical exploration. The effectiveness of this SG-based image explanation and scanning guidance has been validated on images from the left and right neck regions, including the carotid and thyroid, across five volunteers. The results demonstrate the potential of the method to maximally democratize ultrasound by enhancing its interpretability and usability for ordinaries.

Although new vision foundation models such as Segment Anything Model 2 (SAM2) have significantly enhanced zero-shot image segmentation capabilities, reliance on human-provided prompts poses significant challenges in adapting SAM2 to medical image segmentation tasks. Moreover, SAM2's performance in medical image segmentation was limited by the domain shift issue, since it was originally trained on natural images and videos. To address these challenges, we proposed SAM2 with support-set guided prompting (SAM2-SGP), a framework that eliminated the need for manual prompts. The proposed model leveraged the memory mechanism of SAM2 to generate pseudo-masks using image-mask pairs from a support set via a Pseudo-mask Generation (PMG) module. We further introduced a novel Pseudo-mask Attention (PMA) module, which used these pseudo-masks to automatically generate bounding boxes and enhance localized feature extraction by guiding attention to relevant areas. Furthermore, a low-rank adaptation (LoRA) strategy was adopted to mitigate the domain shift issue. The proposed framework was evaluated on both 2D and 3D datasets across multiple medical imaging modalities, including fundus photography, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound. The results demonstrated a significant performance improvement over state-of-the-art models, such as nnUNet and SwinUNet, as well as foundation models, such as SAM2 and MedSAM2, underscoring the effectiveness of the proposed approach. Our code is publicly available at https://github.com/astlian9/SAM_Support.

Long axial field-of-view PET scanners offer increased field-of-view and sensitivity compared to traditional PET scanners. However, a significant cost is associated with the densely packed photodetectors required for the extended-coverage systems, limiting clinical utilisation. To mitigate the cost limitations, alternative sparse system configurations have been proposed, allowing an extended field-of-view PET design with detector costs similar to a standard PET system, albeit at the expense of image quality. In this work, we propose a deep sinogram restoration network to fill in the missing sinogram data. Our method utilises a modified Residual U-Net, trained on clinical PET scans from a GE Signa PET/MR, simulating the removal of 50% of the detectors in a chessboard pattern (retaining only 25% of all lines of response). The model successfully recovers missing counts, with a mean absolute error below two events per pixel, outperforming 2D interpolation in both sinogram and reconstructed image domain. Notably, the predicted sinograms exhibit a smoothing effect, leading to reconstructed images lacking sharpness in finer details. Despite these limitations, the model demonstrates a substantial capacity for compensating for the undersampling caused by the sparse detector configuration. This proof-of-concept study suggests that sparse detector configurations, combined with deep learning techniques, offer a viable alternative to conventional PET scanner designs. This approach supports the development of cost-effective, total body PET scanners, allowing a significant step forward in medical imaging technology.

With access to large-scale, unlabeled medical datasets, researchers are confronted with two questions: Should they attempt to pretrain a custom foundation model on this medical data, or use transfer-learning from an existing generalist model? And, if a custom model is pretrained, are novel methods required? In this paper we explore these questions by conducting a case-study, in which we train a foundation model on a large regional fetal ultrasound dataset of 2M images. By selecting the well-established DINOv2 method for pretraining, we achieve state-of-the-art results on three fetal ultrasound datasets, covering data from different countries, classification, segmentation, and few-shot tasks. We compare against a series of models pretrained on natural images, ultrasound images, and supervised baselines. Our results demonstrate two key insights: (i) Pretraining on custom data is worth it, even if smaller models are trained on less data, as scaling in natural image pretraining does not translate to ultrasound performance. (ii) Well-tuned methods from computer vision are making it feasible to train custom foundation models for a given medical domain, requiring no hyperparameter tuning and little methodological adaptation. Given these findings, we argue that a bias towards methodological innovation should be avoided when developing domain specific foundation models under common computational resource constraints.

Recent developments in neural networks have improved deformable image registration (DIR) by amortizing iterative optimization, enabling fast and accurate DIR results. However, learning-based methods often face challenges with limited training data, large deformations, and tend to underperform compared to iterative approaches when label supervision is unavailable. While iterative methods can achieve higher accuracy in such scenarios, they are considerably slower than learning-based methods. To address these limitations, we propose VoxelOpt, a discrete optimization-based DIR framework that combines the strengths of learning-based and iterative methods to achieve a better balance between registration accuracy and runtime. VoxelOpt uses displacement entropy from local cost volumes to measure displacement signal strength at each voxel, which differs from earlier approaches in three key aspects. First, it introduces voxel-wise adaptive message passing, where voxels with lower entropy receives less influence from their neighbors. Second, it employs a multi-level image pyramid with 27-neighbor cost volumes at each level, avoiding exponential complexity growth. Third, it replaces hand-crafted features or contrastive learning with a pretrained foundational segmentation model for feature extraction. In abdominal CT registration, these changes allow VoxelOpt to outperform leading iterative in both efficiency and accuracy, while matching state-of-the-art learning-based methods trained with label supervision. The source code will be available at https://github.com/tinymilky/VoxelOpt

The success of deep learning in medical imaging applications has led several companies to deploy proprietary models in diagnostic workflows, offering monetized services. Even though model weights are hidden to protect the intellectual property of the service provider, these models are exposed to model stealing (MS) attacks, where adversaries can clone the model's functionality by querying it with a proxy dataset and training a thief model on the acquired predictions. While extensively studied on general vision tasks, the susceptibility of medical imaging models to MS attacks remains inadequately explored. This paper investigates the vulnerability of black-box medical imaging models to MS attacks under realistic conditions where the adversary lacks access to the victim model's training data and operates with limited query budgets. We demonstrate that adversaries can effectively execute MS attacks by using publicly available datasets. To further enhance MS capabilities with limited query budgets, we propose a two-step model stealing approach termed QueryWise. This method capitalizes on unlabeled data obtained from a proxy distribution to train the thief model without incurring additional queries. Evaluation on two medical imaging models for Gallbladder Cancer and COVID-19 classification substantiates the effectiveness of the proposed attack. The source code is available at https://github.com/rajankita/QueryWise.

Artifacts in kilo-Voltage CT (kVCT) imaging degrade image quality, impacting clinical decisions. We propose a deep learning framework for metal artifact reduction (MAR) and domain transformation from kVCT to Mega-Voltage CT (MVCT). The proposed framework, ReMAR-DS, utilizes an encoder-decoder architecture with enhanced feature recalibration, effectively reducing artifacts while preserving anatomical structures. This ensures that only relevant information is utilized in the reconstruction process. By infusing recalibrated features from the encoder block, the model focuses on relevant spatial regions (e.g., areas with artifacts) and highlights key features across channels (e.g., anatomical structures), leading to improved reconstruction of artifact-corrupted regions. Unlike traditional MAR methods, our approach bridges the gap between high-resolution kVCT and artifact-resistant MVCT, enhancing radiotherapy planning. It produces high-quality MVCT-like reconstructions, validated through qualitative and quantitative evaluations. Clinically, this enables oncologists to rely on kVCT alone, reducing repeated high-dose MVCT scans and lowering radiation exposure for cancer patients.

Vascular diseases pose a significant threat to human health, with X-ray angiography established as the gold standard for diagnosis, allowing for detailed observation of blood vessels. However, angiographic X-rays expose personnel and patients to higher radiation levels than non-angiographic X-rays, which are unwanted. Thus, modality translation from non-angiographic to angiographic X-rays is desirable. Data-driven deep approaches are hindered by the lack of paired large-scale X-ray angiography datasets. While making high-quality vascular angiography synthesis crucial, it remains challenging. We find that current medical image synthesis primarily operates at pixel level and struggles to adapt to the complex geometric structure of blood vessels, resulting in unsatisfactory quality of blood vessel image synthesis, such as disconnections or unnatural curvatures. To overcome this issue, we propose a self-supervised method via diffusion models to transform non-angiographic X-rays into angiographic X-rays, mitigating data shortages for data-driven approaches. Our model comprises a diffusion model that learns the distribution of vascular data from diffusion latent, a generator for vessel synthesis, and a mask-based adversarial module. To enhance geometric accuracy, we propose a parametric vascular model to fit the shape and distribution of blood vessels. The proposed method contributes a pipeline and a synthetic dataset for X-ray angiography. We conducted extensive comparative and ablation experiments to evaluate the Angio-Diff. The results demonstrate that our method achieves state-of-the-art performance in synthetic angiography image quality and more accurately synthesizes the geometric structure of blood vessels. The code is available at https://github.com/zfw-cv/AngioDiff.

Regular mammography screening is essential for early breast cancer detection. Deep learning-based risk prediction methods have sparked interest to adjust screening intervals for high-risk groups. While early methods focused only on current mammograms, recent approaches leverage the temporal aspect of screenings to track breast tissue changes over time, requiring spatial alignment across different time points. Two main strategies for this have emerged: explicit feature alignment through deformable registration and implicit learned alignment using techniques like transformers, with the former providing more control. However, the optimal approach for explicit alignment in mammography remains underexplored. In this study, we provide insights into where explicit alignment should occur (input space vs. representation space) and if alignment and risk prediction should be jointly optimized. We demonstrate that jointly learning explicit alignment in representation space while optimizing risk estimation performance, as done in the current state-of-the-art approach, results in a trade-off between alignment quality and predictive performance and show that image-level alignment is superior to representation-level alignment, leading to better deformation field quality and enhanced risk prediction accuracy. The code is available at https://github.com/sot176/Longitudinal_Mammogram_Alignment.git.