This study aims to develop and evaluate a digital twin (DT) framework to enhance adaptive proton therapy for prostate stereotactic body radiotherapy (SBRT), focusing on improving treatment precision for dominant intraprostatic lesions (DILs) while minimizing organ-at-risk (OAR) toxicity. We propose a decision-theoretic (DT) framework combining deep learning (DL)-based deformable image registration (DIR) with a prior treatment database to generate synthetic CTs (sCTs) for predicting interfractional anatomical changes. Using daily CBCT from five prostate SBRT patients with DILs, the framework precomputes multiple plans with high (DT-H) and low (DT-L) similarity sCTs. Plan optimization is performed in RayStation 2023B, assuming a constant RBE of 1.1 and robustly accounting for positional and range uncertainties. Plan quality is evaluated via a modified ProKnow score across two fractions, with reoptimization limited to 10 minutes. Daily CBCT evaluation showed clinical plans often violated OAR constraints (e.g., bladder V20.8Gy, rectum V23Gy), with DIL V100 < 90% in 2 patients, indicating SIFB failure. DT-H plans, using high-similarity sCTs, achieved better or comparable DIL/CTV coverage and lower OAR doses, with reoptimization completed within 10 min (e.g., DT-H-REopt-A score: 154.3-165.9). DT-L plans showed variable outcomes; lower similarity correlated with reduced DIL coverage (e.g., Patient 4: 84.7%). DT-H consistently outperformed clinical plans within time limits, while extended optimization brought DT-L and clinical plans closer to DT-H quality. This DT framework enables rapid, personalized adaptive proton therapy, improving DIL targeting and reducing toxicity. By addressing geometric uncertainties, it supports outcome gains in ultra-hypofractionated prostate RT and lays groundwork for future multimodal anatomical prediction.

Shortcut learning undermines model generalization to out-of-distribution data. While the literature attributes shortcuts to biases in superficial features, we show that imbalances in the semantic distribution of sample embeddings induce spurious semantic correlations, compromising model robustness. To address this issue, we propose SCISSOR (Semantic Cluster Intervention for Suppressing ShORtcut), a Siamese network-based debiasing approach that remaps the semantic space by discouraging latent clusters exploited as shortcuts. Unlike prior data-debiasing approaches, SCISSOR eliminates the need for data augmentation and rewriting. We evaluate SCISSOR on 6 models across 4 benchmarks: Chest-XRay and Not-MNIST in computer vision, and GYAFC and Yelp in NLP tasks. Compared to several baselines, SCISSOR reports +5.3 absolute points in F1 score on GYAFC, +7.3 on Yelp, +7.7 on Chest-XRay, and +1 on Not-MNIST. SCISSOR is also highly advantageous for lightweight models with ~9.5% improvement on F1 for ViT on computer vision datasets and ~11.9% for BERT on NLP. Our study redefines the landscape of model generalization by addressing overlooked semantic biases, establishing SCISSOR as a foundational framework for mitigating shortcut learning and fostering more robust, bias-resistant AI systems.

Background: Accurate lesion segmentation is critical for multiple sclerosis (MS) diagnosis, yet current deep learning approaches face robustness challenges. Aim: This study improves MS lesion segmentation by combining data fusion and deep learning techniques. Materials and Methods: We suggested novel radiomic features (concentration rate and R\'enyi entropy) to characterize different MS lesion types and fused these with raw imaging data. The study integrated radiomic features with imaging data through a ResNeXt-UNet architecture and attention-augmented U-Net architecture. Our approach was evaluated on scans from 46 patients (1102 slices), comparing performance before and after data fusion. Results: The radiomics-enhanced ResNeXt-UNet demonstrated high segmentation accuracy, achieving significant improvements in precision and sensitivity over the MRI-only baseline and a Dice score of 0.774$\pm$0.05; p<0.001 according to Bonferroni-adjusted Wilcoxon signed-rank tests. The radiomics-enhanced attention-augmented U-Net model showed a greater model stability evidenced by reduced performance variability (SDD = 0.18 $\pm$ 0.09 vs. 0.21 $\pm$ 0.06; p=0.03) and smoother validation curves with radiomics integration. Conclusion: These results validate our hypothesis that fusing radiomics with raw imaging data boosts segmentation performance and stability in state-of-the-art models.

Accurate segmentation and classification of brain tumors from Magnetic Resonance Imaging (MRI) remain key challenges in medical image analysis, largely due to the lack of high-quality, balanced, and diverse datasets. In this work, we present a new curated MRI dataset designed specifically for brain tumor segmentation and classification tasks. The dataset comprises 6,000 contrast-enhanced T1-weighted MRI scans annotated by certified radiologists and physicians, spanning three major tumor types-glioma, meningioma, and pituitary-as well as non-tumorous cases. Each sample includes high-resolution labels and is categorized across axial, sagittal, and coronal imaging planes to facilitate robust model development and cross-view generalization. To demonstrate the utility of the dataset, we propose a transformer-based segmentation model and benchmark it against established baselines. Our method achieves the highest weighted mean Intersection-over-Union (IoU) of 82.3%, with improvements observed across all tumor categories. Importantly, this study serves primarily as an introduction to the dataset, establishing foundational benchmarks for future research. We envision this dataset as a valuable resource for advancing machine learning applications in neuro-oncology, supporting both academic research and clinical decision-support development. datasetlink: https://www.kaggle.com/datasets/briscdataset/brisc2025/

Advances in treatment technology now allow for the use of customizable 3D-printed hydrogel wound dressings for patients with osteoradionecrosis (ORN) of the jaw (ONJ). Meanwhile, deep learning has enabled precise segmentation of 3D medical images using tools like nnUNet. However, the scarcity of labeled data in ONJ imaging makes supervised training impractical. This study aims to develop an unsupervised training approach for automatically identifying anomalies in imaging scans. We propose a novel two-stage training pipeline. In the first stage, a VQ-GAN is trained to accurately reconstruct normal subjects. In the second stage, random cube masking and ONJ-specific masking are applied to train a new encoder capable of recovering the data. The proposed method achieves successful segmentation on both simulated and real patient data. This approach provides a fast initial segmentation solution, reducing the burden of manual labeling. Additionally, it has the potential to be directly used for 3D printing when combined with hand-tuned post-processing.

Medical imaging plays a crucial role in assessing knee osteoarthritis (OA) risk by enabling early detection and disease monitoring. Recent machine learning methods have improved risk estimation (i.e., predicting the likelihood of disease progression) and predictive modelling (i.e., the forecasting of future outcomes based on current data) using medical images, but clinical adoption remains limited due to their lack of interpretability. Existing approaches that generate future images for risk estimation are complex and impractical. Additionally, previous methods fail to localize anatomical knee landmarks, limiting interpretability. We address these gaps with a new interpretable machine learning method to estimate the risk of knee OA progression via multi-task predictive modelling that classifies future knee OA severity and predicts anatomical knee landmarks from efficiently generated high-quality future images. Such image generation is achieved by leveraging a diffusion model in a class-conditioned latent space to forecast disease progression, offering a visual representation of how particular health conditions may evolve. Applied to the Osteoarthritis Initiative dataset, our approach improves the state-of-the-art (SOTA) by 2\%, achieving an AUC of 0.71 in predicting knee OA progression while offering ~9% faster inference time.

Accurate diagnosis of brain disorders such as Alzheimer's disease and brain tumors remains a critical challenge in medical imaging. Conventional methods based on manual MRI analysis are often inefficient and error-prone. To address this, we propose DGG-XNet, a hybrid deep learning model integrating VGG16 and DenseNet121 to enhance feature extraction and classification. DenseNet121 promotes feature reuse and efficient gradient flow through dense connectivity, while VGG16 contributes strong hierarchical spatial representations. Their fusion enables robust multiclass classification of neurological conditions. Grad-CAM is applied to visualize salient regions, enhancing model transparency. Trained on a combined dataset from BraTS 2021 and Kaggle, DGG-XNet achieved a test accuracy of 91.33\%, with precision, recall, and F1-score all exceeding 91\%. These results highlight DGG-XNet's potential as an effective and interpretable tool for computer-aided diagnosis (CAD) of neurodegenerative and oncological brain disorders.

The study aimed to identify factors influencing the evolution of chronic lesions in multiple sclerosis (MS) using a machine learning approach. Longitudinal data were collected from individuals with relapsing-remitting multiple sclerosis (RRMS). The "iron rim" sign was identified using quantitative susceptibility mapping (QSM), and microstructural damage was quantified via T1/fluid attenuated inversion recovery (FLAIR) ratios. Additional data included baseline lesion volume, cerebral T2-hyperintense lesion volume, iron rim lesion volume, the proportion of iron rim lesion volume, gender, age, disease duration (DD), disability and cognitive scores, use of disease-modifying therapy, and follow-up intervals. These features were integrated into machine learning models (logistic regression (LR), random forest (RF), and support vector machine (SVM)) to predict lesion volume change, with the most predictive model selected for feature importance analysis. The study included 47 RRMS individuals (mean age, 30.6 ± 8.0 years [standard deviation], 6 males) and 833 chronic lesions. Machine learning model development results showed that the SVM model demonstrated superior predictive efficiency, with an AUC of 0.90 in the training set and 0.81 in the testing set. Feature importance analysis identified the top three features were the "iron rim" sign of lesions, DD, and the T1/FLAIR ratios of the lesions. This study developed a machine learning model to predict the volume outcome of MS lesions. Feature importance analysis identified chronic inflammation around the lesion, DD, and the microstructural damage as key factors influencing volume change in chronic MS lesions. Question The evolution of different chronic lesions in MS exhibits variability, and the driving factors influencing these outcomes remain to be further investigated. Findings A SVM learning model was developed to predict chronic MS lesion volume changes, integrating lesion characteristics, lesion burden, and clinical data. Clinical relevance Chronic inflammation surrounding lesions, DD, and microstructural damage are key factors influencing the evolution of chronic MS lesions.

Cone beam CT is an imaging modality that provides high-resolution, cross-sectional imaging in the fluoroscopy suite. In neuroradiology, cone beam CT has been used for various applications including temporal bone imaging and during spinal and cerebral angiography. Furthermore, cone beam CT has been shown to improve imaging of spinal CSF leaks during myelography. One drawback of cone beam CT is that images have a relatively high noise level. In this technical report, we describe the first application of a high-resolution convolutional neural network to denoise cone beam CT myelographic images. We show examples of the resulting improvement in image quality for a variety of types of spinal CSF leaks. Further application of this technique is warranted to demonstrate its clinical utility and potential use for other cone beam CT applications.ABBREVIATIONS: CBCT = cone beam CT; CB-CTM = cone beam CT myelography; CTA = CT angiography; CVF = CSF-venous fistula; DSM = digital subtraction myelography; EID = energy integrating detector; FBP = filtered back-projection; SNR = signal-to-noise ratio.

The integration of multi-modal Magnetic Resonance Imaging (MRI) and clinical data holds great promise for enhancing the diagnosis of neurological disorders (NDs) in real-world clinical settings. Deep Learning (DL) has recently emerged as a powerful tool for extracting meaningful patterns from medical data to aid in diagnosis. However, existing DL approaches struggle to effectively leverage multi-modal MRI and clinical data, leading to suboptimal performance. To address this challenge, we utilize a unique, proprietary multi-modal clinical dataset curated for ND research. Based on this dataset, we propose a novel transformer-based Mixture-of-Experts (MoE) framework for ND classification, leveraging multiple MRI modalities-anatomical (aMRI), Diffusion Tensor Imaging (DTI), and functional (fMRI)-alongside clinical assessments. Our framework employs transformer encoders to capture spatial relationships within volumetric MRI data while utilizing modality-specific experts for targeted feature extraction. A gating mechanism with adaptive fusion dynamically integrates expert outputs, ensuring optimal predictive performance. Comprehensive experiments and comparisons with multiple baselines demonstrate that our multi-modal approach significantly enhances diagnostic accuracy, particularly in distinguishing overlapping disease states. Our framework achieves a validation accuracy of 82.47\%, outperforming baseline methods by over 10\%, highlighting its potential to improve ND diagnosis by applying multi-modal learning to real-world clinical data.