Accurate measurement of hallux valgus angle (HVA) and intermetatarsal angle (IMA) is essential for diagnosing hallux valgus and determining appropriate treatment strategies. Traditional manual measurement methods, while standardized, are time-consuming, labor-intensive, and subject to evaluator bias. Recent advancements in deep learning have been applied to hallux valgus angle estimation, but the development of effective algorithms requires large, well-annotated datasets. Existing X-ray datasets are typically limited to cropped foot regions images, and only one dataset containing very few samples is publicly available. To address these challenges, we introduce HVAngleEst, the first large-scale, open-access dataset specifically designed for hallux valgus angle estimation. HVAngleEst comprises 1,382 X-ray images from 1,150 patients and includes comprehensive annotations, such as foot localization, hallux valgus angles, and line segments for each phalanx. This dataset enables fully automated, end-to-end hallux valgus angle estimation, reducing manual labor and eliminating evaluator bias.

Medical image challenges have played a transformative role in advancing the field, catalyzing algorithmic innovation and establishing new performance standards across diverse clinical applications. Image registration, a foundational task in neuroimaging pipelines, has similarly benefited from the Learn2Reg initiative. Building on this foundation, we introduce the Large-scale Unsupervised Brain MRI Image Registration (LUMIR) challenge, a next-generation benchmark designed to assess and advance unsupervised brain MRI registration. Distinct from prior challenges that leveraged anatomical label maps for supervision, LUMIR removes this dependency by providing over 4,000 preprocessed T1-weighted brain MRIs for training without any label maps, encouraging biologically plausible deformation modeling through self-supervision. In addition to evaluating performance on 590 held-out test subjects, LUMIR introduces a rigorous suite of zero-shot generalization tasks, spanning out-of-domain imaging modalities (e.g., FLAIR, T2-weighted, T2*-weighted), disease populations (e.g., Alzheimer's disease), acquisition protocols (e.g., 9.4T MRI), and species (e.g., macaque brains). A total of 1,158 subjects and over 4,000 image pairs were included for evaluation. Performance was assessed using both segmentation-based metrics (Dice coefficient, 95th percentile Hausdorff distance) and landmark-based registration accuracy (target registration error). Across both in-domain and zero-shot tasks, deep learning-based methods consistently achieved state-of-the-art accuracy while producing anatomically plausible deformation fields. The top-performing deep learning-based models demonstrated diffeomorphic properties and inverse consistency, outperforming several leading optimization-based methods, and showing strong robustness to most domain shifts, the exception being a drop in performance on out-of-domain contrasts.

Periventricular white matter injury (PWMI) is the most frequent magnetic resonance imaging (MRI) finding in infants with Cerebral Palsy (CP). We aim to detect CP and identify subtle, sparse PWMI lesions in infants under two years of age with immature brain structures. Based on the characteristic that the responsible lesions are located within five target regions, we first construct a multi-modal dataset including 243 cases with the mask annotations of five target regions for delineating anatomical structures on T1-Weighted Imaging (T1WI) images, masks for lesions on T2-Weighted Imaging (T2WI) images, and categories (CP or Non-CP). Furthermore, we develop a bidirectional projection-based multi-modal fusion transformer (BiP-MFT), incorporating a Bidirectional Projection Fusion Module (BPFM) for integrating the features between five target regions on T1WI images and lesions on T2WI images. Our BiP-MFT achieves subject-level classification accuracy of 0.90, specificity of 0.87, and sensitivity of 0.94. It surpasses the best results of nine comparative methods, with 0.10, 0.08, and 0.09 improvements in classification accuracy, specificity and sensitivity respectively. Our BPFM outperforms eight compared feature fusion strategies using Transformer and U-Net backbones on our dataset. Ablation studies on the dataset annotations and model components justify the effectiveness of our annotation method and the model rationality. The proposed dataset and codes are available at https://github.com/Kai-Qi/BiP-MFT.

Multimodal Large Language Models (MLLMs) are of great application across many domains, such as multimodal understanding and generation. With the development of diffusion models (DM) and unified MLLMs, the performance of image generation has been significantly improved, however, the study of image screening is rare and its performance with MLLMs is unsatisfactory due to the lack of data and the week image aesthetic reasoning ability in MLLMs. In this work, we propose a complete solution to address these problems in terms of data and methodology. For data, we collect a comprehensive medical image screening dataset with 1500+ samples, each sample consists of a medical image, four generated images, and a multiple-choice answer. The dataset evaluates the aesthetic reasoning ability under four aspects: \textit{(1) Appearance Deformation, (2) Principles of Physical Lighting and Shadow, (3) Placement Layout, (4) Extension Rationality}. For methodology, we utilize long chains of thought (CoT) and Group Relative Policy Optimization with Dynamic Proportional Accuracy reward, called DPA-GRPO, to enhance the image aesthetic reasoning ability of MLLMs. Our experimental results reveal that even state-of-the-art closed-source MLLMs, such as GPT-4o and Qwen-VL-Max, exhibit performance akin to random guessing in image aesthetic reasoning. In contrast, by leveraging the reinforcement learning approach, we are able to surpass the score of both large-scale models and leading closed-source models using a much smaller model. We hope our attempt on medical image screening will serve as a regular configuration in image aesthetic reasoning in the future.

Artificial intelligence (AI)-based chest X-ray (CXR) interpretation assistants have demonstrated significant progress and are increasingly being applied in clinical settings. However, contemporary medical AI models often adhere to a simplistic input-to-output paradigm, directly processing an image and an instruction to generate a result, where the instructions may be integral to the model's architecture. This approach overlooks the modeling of the inherent diagnostic reasoning in chest X-ray interpretation. Such reasoning is typically sequential, where each interpretive stage considers the images, the current task, and the contextual information from previous stages. This oversight leads to several shortcomings, including misalignment with clinical scenarios, contextless reasoning, and untraceable errors. To fill this gap, we construct CXRTrek, a new multi-stage visual question answering (VQA) dataset for CXR interpretation. The dataset is designed to explicitly simulate the diagnostic reasoning process employed by radiologists in real-world clinical settings for the first time. CXRTrek covers 8 sequential diagnostic stages, comprising 428,966 samples and over 11 million question-answer (Q&A) pairs, with an average of 26.29 Q&A pairs per sample. Building on the CXRTrek dataset, we propose a new vision-language large model (VLLM), CXRTrekNet, specifically designed to incorporate the clinical reasoning flow into the VLLM framework. CXRTrekNet effectively models the dependencies between diagnostic stages and captures reasoning patterns within the radiological context. Trained on our dataset, the model consistently outperforms existing medical VLLMs on the CXRTrek benchmarks and demonstrates superior generalization across multiple tasks on five diverse external datasets. The dataset and model can be found in our repository (https://github.com/guanjinquan/CXRTrek).

We propose a cascaded 3D diffusion model framework to synthesize high-fidelity 3D PET/CT volumes directly from demographic variables, addressing the growing need for realistic digital twins in oncologic imaging, virtual trials, and AI-driven data augmentation. Unlike deterministic phantoms, which rely on predefined anatomical and metabolic templates, our method employs a two-stage generative process. An initial score-based diffusion model synthesizes low-resolution PET/CT volumes from demographic variables alone, providing global anatomical structures and approximate metabolic activity. This is followed by a super-resolution residual diffusion model that refines spatial resolution. Our framework was trained on 18-F FDG PET/CT scans from the AutoPET dataset and evaluated using organ-wise volume and standardized uptake value (SUV) distributions, comparing synthetic and real data between demographic subgroups. The organ-wise comparison demonstrated strong concordance between synthetic and real images. In particular, most deviations in metabolic uptake values remained within 3-5% of the ground truth in subgroup analysis. These findings highlight the potential of cascaded 3D diffusion models to generate anatomically and metabolically accurate PET/CT images, offering a robust alternative to traditional phantoms and enabling scalable, population-informed synthetic imaging for clinical and research applications.

Liver cirrhosis represents the end stage of chronic liver disease, characterized by extensive fibrosis and nodular regeneration that significantly increases mortality risk. While magnetic resonance imaging (MRI) offers a non-invasive assessment, accurately segmenting cirrhotic livers presents substantial challenges due to morphological alterations and heterogeneous signal characteristics. Deep learning approaches show promise for automating these tasks, but progress has been limited by the absence of large-scale, annotated datasets. Here, we present CirrMRI600+, the first comprehensive dataset comprising 628 high-resolution abdominal MRI scans (310 T1-weighted and 318 T2-weighted sequences, totaling nearly 40,000 annotated slices) with expert-validated segmentation labels for cirrhotic livers. The dataset includes demographic information, clinical parameters, and histopathological validation where available. Additionally, we provide benchmark results from 11 state-of-the-art deep learning experiments to establish performance standards. CirrMRI600+ enables the development and validation of advanced computational methods for cirrhotic liver analysis, potentially accelerating progress toward automated Cirrhosis visual staging and personalized treatment planning.

Deformable image registration (DIR) is an enabling technology in many diagnostic and therapeutic tasks. Despite this, DIR algorithms have limited clinical use, largely due to a lack of benchmark datasets for quality assurance during development. DIRs of intra-patient abdominal CTs are among the most challenging registration scenarios due to significant organ deformations and inconsistent image content. To support future algorithm development, here we introduce our first-of-its-kind abdominal CT DIR benchmark dataset, comprising large numbers of highly accurate landmark pairs on matching blood vessel bifurcations. Abdominal CT image pairs of 30 patients were acquired from several publicly available repositories as well as the authors' institution with IRB approval. The two CTs of each pair were originally acquired for the same patient but on different days. An image processing workflow was developed and applied to each CT image pair: (1) Abdominal organs were segmented with a deep learning model, and image intensity within organ masks was overwritten. (2) Matching image patches were manually identified between two CTs of each image pair. (3) Vessel bifurcation landmarks were labeled on one image of each image patch pair. (4) Image patches were deformably registered, and landmarks were projected onto the second image. (5) Landmark pair locations were refined manually or with an automated process. This workflow resulted in 1895 total landmark pairs, or 63 per case on average. Estimates of the landmark pair accuracy using digital phantoms were 0.7 mm ± 1.2 mm. The data are published in Zenodo at https://doi.org/10.5281/zenodo.14362785. Instructions for use can be found at https://github.com/deshanyang/Abdominal-DIR-QA. This dataset is a first-of-its-kind for abdominal DIR validation. The number, accuracy, and distribution of landmark pairs will allow for robust validation of DIR algorithms with precision beyond what is currently available.

The integration of artificial intelligence (AI) with radiology signifies a transformative era in medicine. Vision foundation models have been adopted to enhance radiologic imaging analysis. However, the inherent complexities of 2D and 3D radiologic data present unique challenges that existing models, which are typically pretrained on general nonmedical images, do not adequately address. To bridge this gap and harness the diagnostic precision required in radiologic imaging, we introduce radiologic contrastive language-image pretraining (RadCLIP): a cross-modal vision-language foundational model that utilizes a vision-language pretraining (VLP) framework to improve radiologic image analysis. Building on the contrastive language-image pretraining (CLIP) approach, RadCLIP incorporates a slice pooling mechanism designed for volumetric image analysis and is pretrained using a large, diverse dataset of radiologic image-text pairs. This pretraining effectively aligns radiologic images with their corresponding text annotations, resulting in a robust vision backbone for radiologic imaging. Extensive experiments demonstrate RadCLIP's superior performance in both unimodal radiologic image classification and cross-modal image-text matching, underscoring its significant promise for enhancing diagnostic accuracy and efficiency in clinical settings. Our key contributions include curating a large dataset featuring diverse radiologic 2D/3D image-text pairs, pretraining RadCLIP as a vision-language foundation model on this dataset, developing a slice pooling adapter with an attention mechanism for integrating 2D images, and conducting comprehensive evaluations of RadCLIP on various radiologic downstream tasks.

Planning an osteotomy or arthroplasty surgery on a lower limb requires prior classification/identification of its deformities. The detection of skeletal landmarks and the calculation of angles required to identify the deformities are traditionally done manually, with measurement accuracy relying considerably on the experience of the individual doing the measurements. We propose a novel, image pyramid-based approach to skeletal landmark detection. The proposed approach uses a Convolutional Neural Network (CNN) that receives the raw X-ray image as input and produces the coordinates of the landmarks. The landmark estimations are modified iteratively via the error feedback method to come closer to the target. Our clinically produced full-leg X-Rays dataset is made publically available and used to train and test the network. Angular quantities are calculated based on detected landmarks. Angles are then classified as lower than normal, normal or higher than normal according to predefined ranges for a normal condition. The performance of our approach is evaluated at several levels: landmark coordinates accuracy, angles' measurement accuracy, and classification accuracy. The average absolute error (difference between automatically and manually determined coordinates) for landmarks was 0.79 ± 0.57 mm on test data, and the average absolute error (difference between automatically and manually calculated angles) for angles was 0.45 ± 0.42°. Results from multiple case studies involving high-resolution images show that the proposed approach outperforms previous deep learning-based approaches in terms of accuracy and computational cost. It also enables the automatic detection of the lower limb misalignments in full-leg x-ray images.