Medical imaging foundation models must adapt over time, yet full retraining is often blocked by privacy constraints and cost. We present a continual learning framework that avoids storing patient exemplars by pairing class conditional diffusion replay with Elastic Weight Consolidation. Using a compact Vision Transformer backbone, we evaluate across eight MedMNIST v2 tasks and CheXpert. On CheXpert our approach attains 0.851 AUROC, reduces forgetting by more than 30\% relative to DER\texttt{++}, and approaches joint training at 0.869 AUROC, while remaining efficient and privacy preserving. Analyses connect forgetting to two measurable factors: fidelity of replay and Fisher weighted parameter drift, highlighting the complementary roles of replay diffusion and synaptic stability. The results indicate a practical route for scalable, privacy aware continual adaptation of clinical imaging models.

Deep learning models are increasingly used for radiographic analysis, but their reliability is challenged by the stochastic noise inherent in clinical imaging. A systematic, cross-task understanding of how different noise types impact these models is lacking. Here, we evaluate the robustness of state-of-the-art convolutional neural networks (CNNs) to simulated quantum (Poisson) and electronic (Gaussian) noise in two key chest X-ray tasks: semantic segmentation and pulmonary disease classification. Using a novel, scalable noise injection framework, we applied controlled, clinically-motivated noise severities to common architectures (UNet, DeepLabV3, FPN; ResNet, DenseNet, EfficientNet) on public datasets (Landmark, ChestX-ray14). Our results reveal a stark dichotomy in task robustness. Semantic segmentation models proved highly vulnerable, with lung segmentation performance collapsing under severe electronic noise (Dice Similarity Coefficient drop of 0.843), signifying a near-total model failure. In contrast, classification tasks demonstrated greater overall resilience, but this robustness was not uniform. We discovered a differential vulnerability: certain tasks, such as distinguishing Pneumothorax from Atelectasis, failed catastrophically under quantum noise (AUROC drop of 0.355), while others were more susceptible to electronic noise. These findings demonstrate that while classification models possess a degree of inherent robustness, pixel-level segmentation tasks are far more brittle. The task- and noise-specific nature of model failure underscores the critical need for targeted validation and mitigation strategies before the safe clinical deployment of diagnostic AI.

In recent years, lung function assessment has attracted increasing attention in the perioperative management of thoracic surgery. However, traditional pulmonary function testing methods remain limited in clinical practice due to high equipment requirements and complex procedures. With the rapid development of artificial intelligence (AI) technology, lung function assessment based on multimodal chest imaging (such as X-rays, CT, and MRI) has become a new research focus. Through deep learning algorithms, AI models can accurately extract imaging features of patients and have made significant progress in quantitative analysis of pulmonary ventilation, evaluation of diffusion capacity, measurement of lung volumes, and prediction of lung function decline. Previous studies have demonstrated that AI models perform well in predicting key indicators such as forced expiratory volume in one second (FEV1), diffusing capacity for carbon monoxide (DLCO), and total lung capacity (TLC). Despite these promising prospects, challenges remain in clinical translation, including insufficient data standardization, limited model interpretability, and the lack of prediction models for postoperative complications. In the future, greater emphasis should be placed on multicenter collaboration, the construction of high-quality databases, the promotion of multimodal data integration, and clinical validation to further enhance the application value of AI technology in precision decision-making for thoracic surgery.

Interstitial lung disease (ILD) is a leading cause of morbidity and mortality in systemic sclerosis (SSc). Chest computed tomography (CT) is the primary imaging modality for diagnosing and monitoring lung complications in SSc patients. However, its role in disease progression and mortality prediction has not yet been fully clarified. This study introduces a novel, large-scale longitudinal chest CT analysis framework that utilizes radiomics and deep learning to predict mortality associated with lung complications of SSc. We collected and analyzed 2,125 CT scans from SSc patients enrolled in the Northwestern Scleroderma Registry, conducting mortality analyses at one, three, and five years using advanced imaging analysis techniques. Death labels were assigned based on recorded deaths over the one-, three-, and five-year intervals, confirmed by expert physicians. In our dataset, 181, 326, and 428 of the 2,125 CT scans were from patients who died within one, three, and five years, respectively. Using ResNet-18, DenseNet-121, and Swin Transformer we use pre-trained models, and fine-tuned on 2,125 images of SSc patients. Models achieved an AUC of 0.769, 0.801, 0.709 for predicting mortality within one-, three-, and five-years, respectively. Our findings highlight the potential of both radiomics and deep learning computational methods to improve early detection and risk assessment of SSc-related interstitial lung disease, marking a significant advancement in the literature.

BackgroundIncarceration is a leading driver of tuberculosis in Latin America. Active case-finding in prisons may reduce population-wide tuberculosis burden, but optimal strategies and cost-effectiveness remain uncertain. Methods and findingsUsing dynamic transmission models calibrated to Brazil, Colombia, and Peru, we simulated annual or biannual (twice-yearly) prison-wide screening, alone or combined with entry and exit screening from 2026-2035. We evaluated four algorithms: 1) symptom screening, 2) chest X-ray with computer-aided detection (CXR-CAD), 3) symptoms and CXR-CAD (follow-up testing if either is positive) and 4) GeneXpert Ultra with pooled sputum. Individuals screening positive then received individual Xpert. We projected impacts on within-prison and population-level tuberculosis incidence in 2035, along with discounted costs (2023 USD) and disability-adjusted life years (DALYs). Model projections showed that combined entry, exit, and biannual screening with CXR-CAD was highly impactful and cost-effective across countries, reducing tuberculosis incidence by 62-87% in prisons and 18-28% population-wide. Compared to only biannual CXR-CAD (the next best strategy), the incremental cost per DALY averted of adding entry and exit screening was $2984 (Brazil), $2925 (Colombia), and $645 (Peru). Adding symptom screening to CXR-CAD marginally increased benefit and was only cost-effective in Perus higher-incidence prisons. Biannual screening alone remained cost-effective at prison incidence levels well below national averages. In settings without CXR-CAD, pooled Xpert was an impactful, cost-effective alternative. ConclusionsThese modeling results support immediate national-level adoption of prison-wide tuberculosis screening twice-yearly and at entry and exit. Screening should begin with available methods while building capacity for CXR-CAD, the most cost-effective algorithm. AUTHOR SUMMARYO_ST_ABSWhy was this study done?C_ST_ABSO_LIIn Latin America, rising incarceration has fueled the tuberculosis epidemic, with extremely high infection rates among people deprived of liberty. These effects extend beyond prison walls, driving tuberculosis spread in outside communities. C_LIO_LIInterventions targeted to prisons may have an outsized impact on reducing tuberculosis in the broader population. C_LIO_LIThe World Health Organization strongly recommends systematic screening for tuberculosis in prisons, but there is little evidence on how often to screen, which methods to use, and whether these approaches are cost-effective across different country contexts. C_LI What did the researchers do and find?O_LIWe developed mathematical models using data from Brazil, Colombia, and Peru to simulate different prison-based tuberculosis screening strategies and project their health impacts and costs. C_LIO_LIWe compared prison-wide screening once or twice a year, screening at prison entry or exit, and combinations of these approaches. We also compared different screening methods using symptoms, chest X-ray with computer-aided detection (CXR-CAD), or pooled molecular testing (GeneXpert Ultra). C_LIO_LIThe models projected that combining entry, exit, and twice-yearly prison-wide screening with CXR-CAD would be highly impactful and cost-effective in all three countries. This strategy could substantially reduce tuberculosis in prisons and in the general population. C_LIO_LITwice-yearly prison-wide screening remained cost-effective even in prisons with much lower tuberculosis rates than national averages. C_LIO_LICXR-CAD was the optimal screening method, but pooled molecular testing was also impactful and cost-effective where CXR-CAD was not available. C_LI Implications of all the available evidenceO_LISystematic screening in prisons, twice-yearly and at entry and exit, is projected to be highly impactful and cost-effective across different settings in Latin America. C_LIO_LIThese findings support urgent adoption of intensive prison-based tuberculosis screening throughout the region, starting with the best available diagnostic tools while investing in CXR-CAD. C_LI

The COVID-19 pandemic has been the most catastrophic global health emergency of the [Formula: see text] century, resulting in hundreds of millions of reported cases and five million deaths. Chest X-ray (CXR) images are highly valuable for early detection of lung diseases in monitoring and investigating pulmonary disorders such as COVID-19, pneumonia, and tuberculosis. These CXR images offer crucial features about the lung's health condition and can assist in making accurate diagnoses. Manual interpretation of CXR images is challenging even for expert radiologists due to the overlapping radiological features. Therefore, Artificial Intelligence (AI) based image processing took over the charge in healthcare. But still it is uncertain to trust the prediction results by an AI model. However, this can be resolved by implementing explainable artificial intelligence (XAI) tools that transform a black-box AI into a glass-box model. In this research article, we have proposed a novel XAI-TRANS model with inception based transfer learning addressing the challenge of overlapping features in multiclass classification of CXR images. Also, we proposed an improved U-Net Lung segmentation dedicated to obtaining the radiological features for classification. The proposed approach achieved a maximum precision of 98% and accuracy of 97% in multiclass lung disease classification. By leveraging XAI techniques with the evident improvement of 4.75%, specifically LIME and Grad-CAM, to provide detailed and accurate explanations for the model's prediction.

SARS-CoV-2, the causative agent of COVID-19, remains a global health concern due to its high transmissibility and evolving variants. Although vaccination efforts and therapeutic advancements have mitigated disease severity, emerging mutations continue to challenge diagnostics and containment strategies. As of mid-February 2025, global test positivity has risen to 11%, marking the highest level in over 6 months, despite widespread immunization efforts. Newer variants demonstrate enhanced host cell binding, increasing both infectivity and diagnostic complexity. This study aimed to evaluate the effectiveness of deep transfer learning in delivering a rapid, accurate, and mutation-resilient COVID-19 diagnosis from medical imaging, with a focus on scalability and accessibility. An automated detection system was developed using state-of-the-art convolutional neural networks, including VGG16 (Visual Geometry Group network-16 layers), ResNet50 (residual network-50 layers), ConvNeXtTiny (convolutional next-tiny), MobileNet (mobile network), NASNetMobile (neural architecture search network-mobile version), and DenseNet121 (densely connected convolutional network-121 layers), to detect COVID-19 from chest X-ray and computed tomography (CT) images. Among all the models evaluated, DenseNet121 emerged as the best-performing architecture for COVID-19 diagnosis using X-ray and CT images. It achieved an impressive accuracy of 98%, with a precision of 96.9%, a recall of 98.9%, an F1-score of 97.9%, and an area under the curve score of 99.8%, indicating a high degree of consistency and reliability in detecting both positive and negative cases. The confusion matrix showed minimal false positives and false negatives, underscoring the model's robustness in real-world diagnostic scenarios. Given its performance, DenseNet121 is a strong candidate for deployment in clinical settings and serves as a benchmark for future improvements in artificial intelligence-assisted diagnostic tools. The study results underscore the potential of artificial intelligence-powered diagnostics in supporting early detection and global pandemic response. With careful optimization, deep learning models can address critical gaps in testing, particularly in settings constrained by limited resources or emerging variants.

The preoperative differentiation of adenocarcinomas in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma using computed tomography (CT) is crucial for guiding clinical management decisions. However, accurately classifying ground-glass nodules poses a significant challenge. Incorporating quantitative intratumoral heterogeneity scores may improve the accuracy of this ternary classification. In this multicenter retrospective study, we developed ternary classification models by leveraging insights from both base and stacking ensemble machine learning models, incorporating intratumoral heterogeneity scores along with clinical-radiological features to distinguish adenocarcinomas in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma. The machine learning models were trained, and final model selection depended on maximizing the macro-average area under the curve (macro-AUC) in both the internal and external validation sets. Data from 802 patients from three centers were divided into a training set (n = 477) and an internal test set (n = 205), in a 7:3 ratio, with an additional external validation set comprising 120 patients. The stacking classifier exhibited superior performance relative to the other models, achieving macro-AUC values of 0.7850 and 0.7717 for the internal and external validation sets, respectively. Moreover, an interpretability analysis utilizing the Shapley Additive Explanation identified four key features of this ternary classification: intratumoral heterogeneity score, nodule size, nodule type, and age. The stacking classifier, recognized as the optimal algorithm for integrating the intratumoral heterogeneity score and clinical-radiological features, effectively served as a ternary classification model for assessing the invasiveness of lung adenocarcinoma in chest CT images. Our stacking classifier integrated intratumoral heterogeneity scores and clinical-radiological features to improve the ternary classification of lung adenocarcinoma invasiveness (adenocarcinomas in situ/minimally invasive adenocarcinoma/invasive adenocarcinoma), aiding in precise diagnosis and clinical decision-making for ground-glass nodules. The intratumoral heterogeneity score effectively assessed the invasiveness of lung adenocarcinoma. The stacking classifier outperformed other methods for this ternary classification task. Intratumoral heterogeneity score, nodule size, nodule type, and age predict invasiveness.

Deep learning integration into medical imaging systems has transformed disease detection and diagnosis processes with a focus on pneumonia identification. The study introduces an intricate deep learning system using Convolutional Neural Networks for automated pneumonia detection from chest Xray images which boosts diagnostic precision and speed. The proposed CNN architecture integrates sophisticated methods including separable convolutions along with batch normalization and dropout regularization to enhance feature extraction while reducing overfitting. Through the application of data augmentation techniques and adaptive learning rate strategies the model underwent training on an extensive collection of chest Xray images to enhance its generalization capabilities. A convoluted array of evaluation metrics such as accuracy, precision, recall, and F1 score collectively verify the model exceptional performance by recording an accuracy rate of 91. This study tackles critical clinical implementation obstacles such as data privacy protection, model interpretability, and integration with current healthcare systems beyond just model performance. This approach introduces a critical advancement by integrating medical ontologies with semantic technology to improve diagnostic accuracy. The study enhances AI diagnostic reliability by integrating machine learning outputs with structured medical knowledge frameworks to boost interpretability. The findings demonstrate AI powered healthcare tools as a scalable efficient pneumonia detection solution. This study advances AI integration into clinical settings by developing more precise automated diagnostic methods that deliver consistent medical imaging results.

Deep learning necessitates a substantial amount of data, yet obtaining sufficient medical images is difficult due to concerns about patient privacy and high collection costs. To address this issue, we propose a conditional latent diffusion model-based medical image enhancement network, referred to as the Medical Image Enhancement Network (MedIENet). To meet the rigorous standards required for image generation in the medical imaging field, a multi-attention module is incorporated in the encoder of the denoising U-Net backbone. Additionally Rotary Position Embedding (RoPE) is integrated into the self-attention module to effectively capture positional information, while cross-attention is utilised to embed integrate class information into the diffusion process. MedIENet is evaluated on three datasets: Chest CT-Scan images, Chest X-Ray Images (Pneumonia), and Tongue dataset. Compared to existing methods, MedIENet demonstrates superior performance in both fidelity and diversity of the generated images. Experimental results indicate that for downstream classification tasks using ResNet50, the Area Under the Receiver Operating Characteristic curve (AUROC) achieved with real data alone is 0.76 for the Chest CT-Scan images dataset, 0.87 for the Chest X-Ray Images (Pneumonia) dataset, and 0.78 for the Tongue Dataset. When using mixed data consisting of real data and generated data, the AUROC improves to 0.82, 0.94, and 0.82, respectively, reflecting increases of approximately 6%, 7%, and 4%. These findings indicate that the images generated by MedIENet can enhance the performance of downstream classification tasks, providing an effective solution to the scarcity of medical image training data.