Integration of AI and XR in TAVR is revolutionizing the management of severe aortic stenosis by enhancing diagnostic accuracy, risk stratification, and pre-procedural planning. Advanced algorithms now facilitate precise electrocardiographic, echocardiographic, and CT-based assessments that reduce observer variability and enable patient-specific risk prediction. Immersive XR technologies, including augmented, virtual, and mixed reality, improve spatial visualization of complex cardiac anatomy and support real-time procedural guidance. Despite these advancements, standardized protocols, regulatory frameworks, and ethical safeguards remain necessary for widespread clinical adoption.

Efficient and accurate preoperative assessment of the right-sided heart structural complex (RSHSc) is crucial for planning transcatheter tricuspid valve replacement (TTVR). However, current manual methods remain time-consuming and inconsistent. To address this unmet clinical need, this study aimed to develop and validate TRI-PLAN, the first fully automated, deep learning (DL)-based framework for pre-TTVR assessment. A total of 140 preprocedural computed tomography angiography (CTA) scans (63,962 slices) from patients with severe tricuspid regurgitation (TR) at two high-volume cardiac centers in China were retrospectively included. The patients were divided into a training cohort (n = 100), an internal validation cohort (n = 20), and an external validation cohort (n = 20). TRI-PLAN was developed by a dual-stage right heart assessment network (DRA-Net) to segment the RSHSc and localize the tricuspid annulus (TA), followed by automated measurement of key anatomical parameters and right ventricular ejection fraction (RVEF). Performance was comprehensively evaluated in terms of accuracy, interobserver benchmark comparison, clinical usability, and workflow efficiency. TRI-PLAN achieved expert-level segmentation accuracy (volumetric Dice 0.952/0.955; surface Dice 0.934/0.940), precise localization (standard deviation 1.18/1.14 mm), excellent measurement agreement (ICC 0.984/0.979) and reliable RVEF evaluation (R = 0.97, bias<5 %) across internal and external cohorts. In addition, TRI-PLAN obtained a direct acceptance rate of 80 % and reduced total assessment time from 30 min manually to under 2 min (>95 % time saving). TRI-PLAN provides an accurate, efficient, and clinically applicable solution for pre-TTVR assessment, with strong potential to streamline TTVR planning and enhance procedural outcomes.

Existing Lung Cancer Diagnosis (LCD) models have difficulty in detecting early-stage lung cancer due to the asymptomatic nature of the disease which leads to an increased death rate of patients. Therefore, it is important to diagnose lung disease at an early stage to save the lives of affected persons. Hence, the research work aims to develop an efficient lung disease diagnosis using deep learning techniques for the early and accurate detection of lung cancer. This is achieved by. Initially, the proposed model collects the mandatory CT images from the standard benchmark datasets. Then, the lung cancer segmentation is done by using the development of Hybrid Convolution (2D/3D)-based Adaptive DenseUnet with Attention mechanism (HC-ADAM). The Hybrid Sewing Training with Spider Monkey Optimization (HSTSMO) is introduced to optimize the parameters in the developed HC-ADAM segmentation approach. Finally, the dissected lung nodule imagery is considered for the lung cancer classification stage, where the Hybrid Adaptive Dilated Networks with Attention mechanism (HADN-AM) are implemented with the serial cascading of ResNet and Long Short Term Memory (LSTM) for attaining better categorization performance. The accuracy, precision, and F1-score of the developed model for the LIDC-IDRI dataset are 96.3%, 96.38%, and 96.36%, respectively.

Augmented reality (AR) enhances surgical navigation by superimposing visible anatomical structures with three-dimensional virtual models using head-mounted displays (HMDs). In particular, interventions such as open liver surgery can benefit from AR navigation, as it aids in identifying and distinguishing tumors and risk structures. However, there is a lack of automatic and markerless methods that are robust against real-world challenges, such as partial occlusion and organ motion. We introduce a novel multi-device approach for automatic live navigation in open liver surgery that enhances the visualization and interaction capabilities of a HoloLens 2 HMD through precise and reliable registration using an Intel RealSense RGB-D camera. The intraoperative RGB-D segmentation and the preoperative CT data are utilized to register a virtual liver model to the target anatomy. An AR-prompted Segment Anything Model (SAM) enables robust segmentation of the liver in situ without the need for additional training data. To mitigate algorithmic latency, Double Exponential Smoothing (DES) is applied to forecast registration results. We conducted a phantom study for open liver surgery, investigating various scenarios of liver motion, viewpoints, and occlusion. The mean registration errors (8.31 mm-18.78 mm TRE) are comparable to those reported in prior work, while our approach demonstrates high success rates even for high occlusion factors and strong motion. Using forecasting, we bypassed the algorithmic latency of 79.8 ms per frame, with median forecasting errors below 2 mms and 1.5 degrees between the quaternions. To our knowledge, this is the first work to approach markerless in situ visualization by combining a multi-device method with forecasting and a foundation model for segmentation and tracking. This enables a more reliable and precise AR registration of surgical targets with low latency. Our approach can be applied to other surgical applications and AR hardware with minimal effort.

&#xD;Computed tomography perfusion (CTP) imaging is a rapid diagnostic tool for acute stroke but is less robust when tissue time-attenuation curves are truncated. This study proposes an unsupervised learning method for generating perfusion maps from truncated CTP images. Real brain CTP images were artificially truncated to 15% and 30% of the original scan time. Perfusion maps of complete and truncated CTP images were calculated using the proposed method and compared with standard singular value decomposition (SVD), tensor total variation (TTV), nonlinear regression (NLR), and spatio-temporal perfusion physics-informed neural network (SPPINN).&#xD;Main results.&#xD;The NLR method yielded many perfusion values outside physiological ranges, indicating a lack of robustness. The proposed method did not improve the estimation of cerebral blood flow compared to both the SVD and TTV methods, but reduced the effect of truncation on the estimation of cerebral blood volume, with a relative difference of 15.4% in the infarcted region for 30% truncation (20.7% for SVD and 19.4% for TTV). The proposed method also showed better resistance to 30% truncation for mean transit time, with a relative difference of 16.6% in the infarcted region (25.9% for SVD and 26.2% for TTV). Compared to the SPPINN method, the proposed method had similar responses to truncation in gray and white matter, but was less sensitive to truncation in the infarcted region. These results demonstrate the feasibility of using unsupervised learning to generate perfusion maps from CTP images and improve robustness under truncation scenarios.&#xD.

Purpose: Radiation pneumonitis (RP) is a serious complication of intensity-modulated radiation therapy (IMRT) for breast cancer patients, underscoring the need for precise and explainable predictive models. This study presents an Explainable Dual-Omics Filtering (EDOF) model that integrates spatially localized dosiomic and radiomic features for voxel-level RP prediction. Methods: A retrospective cohort of 72 breast cancer patients treated with IMRT was analyzed, including 28 who developed RP. The EDOF model consists of two components: (1) dosiomic filtering, which extracts local dose intensity and spatial distribution features from planning dose maps, and (2) radiomic filtering, which captures texture-based features from pre-treatment CT scans. These features are jointly analyzed using the Explainable Boosting Machine (EBM), a transparent machine learning model that enables feature-specific risk evaluation. Model performance was assessed using five-fold cross-validation, reporting area under the curve (AUC), sensitivity, and specificity. Feature importance was quantified by mean absolute scores, and Partial Dependence Plots (PDPs) were used to visualize nonlinear relationships between RP risk and dual-omic features. Results: The EDOF model achieved strong predictive performance (AUC = 0.95 +- 0.01; sensitivity = 0.81 +- 0.05). The most influential features included dosiomic Intensity Mean, dosiomic Intensity Mean Absolute Deviation, and radiomic SRLGLE. PDPs revealed that RP risk increases beyond 5 Gy and rises sharply between 10-30 Gy, consistent with clinical dose thresholds. SRLGLE also captured structural heterogeneity linked to RP in specific lung regions. Conclusion: The EDOF framework enables spatially resolved, explainable RP prediction and may support personalized radiation planning to mitigate pulmonary toxicity.

Radiotherapy treatment planning often relies on time-consuming, trial-and-error adjustments that heavily depend on the expertise of specialists, while existing deep learning methods face limitations in generalization, prediction accuracy, and clinical applicability. To tackle these challenges, we propose ADDiff-Dose, an Anatomical-Dose Dual Constraints Conditional Diffusion Model for end-to-end multi-tumor dose prediction. The model employs LightweightVAE3D to compress high-dimensional CT data and integrates multimodal inputs, including target and organ-at-risk (OAR) masks and beam parameters, within a progressive noise addition and denoising framework. It incorporates conditional features via a multi-head attention mechanism and utilizes a composite loss function combining MSE, conditional terms, and KL divergence to ensure both dosimetric accuracy and compliance with clinical constraints. Evaluation on a large-scale public dataset (2,877 cases) and three external institutional cohorts (450 cases in total) demonstrates that ADDiff-Dose significantly outperforms traditional baselines, achieving an MAE of 0.101-0.154 (compared to 0.316 for UNet and 0.169 for GAN models), a DICE coefficient of 0.927 (a 6.8% improvement), and limiting spinal cord maximum dose error to within 0.1 Gy. The average plan generation time per case is reduced to 22 seconds. Ablation studies confirm that the structural encoder enhances compliance with clinical dose constraints by 28.5%. To our knowledge, this is the first study to introduce a conditional diffusion model framework for radiotherapy dose prediction, offering a generalizable and efficient solution for automated treatment planning across diverse tumor sites, with the potential to substantially reduce planning time and improve clinical workflow efficiency.

Pancreatic ductal adenocarcinoma (PDAC) exhibits high metastatic potential, with distinct prognoses based on metastatic sites. Radiomics enables quantitative imaging analysis for predictive modeling. To evaluate the feasibility of radiomic models in predicting PDAC metastatic patterns, specifically distinguishing between hepatic and pulmonary metastases. This retrospective study included 115 PDAC patients with either liver (n = 94) or lung (n = 21) metastases. Radiomic features were extracted from pancreatic arterial and venous phase CT scans of primary tumors using PyRadiomics. Two radiologists independently segmented tumors for inter-reader reliability assessment. Features with ICC > 0.9 underwent LASSO regularization for feature selection. Class imbalance was addressed using SMOTE and class weighting. Model performance was evaluated using fivefold cross-validation and bootstrap resampling. The multivariate logistic regression model achieved an AUC-ROC of 0.831 (95% CI: 0.752-0.910). At the optimal threshold, sensitivity was 0.762 (95% CI: 0.659-0.865) and specificity was 0.787 (95% CI: 0.695-0.879). The negative predictive value for lung metastases was 0.810 (95% CI: 0.734-0.886). LargeDependenceEmphasis showed a trend toward significance (p = 0.0566) as a discriminative feature. Precision was 0.842, recall 0.762, and F1 score 0.800. Radiomic analysis of primary pancreatic tumors demonstrates potential for predicting hepatic versus pulmonary metastatic patterns. The high negative predictive value for lung metastases may support clinical decision-making. External validation is essential before clinical implementation. These findings from a single-center study require confirmation in larger, multicenter cohorts.

For patients with locally advanced cervical cancer (LACC), precise survival prediction models could guide personalized treatment. We developed and validated CerviPro, a deep learning-based multimodal prognostic model, to predict disease-free survival (DFS) in 1018 patients with LACC receiving definitive radiotherapy. The model integrates pre- and post-treatment CT imaging, handcrafted radiomic features, and clinical variables. CerviPro demonstrated robust predictive performance in the internal validation cohort (C-index 0.81), and external validation cohorts (C-index 0.70&0.66), significantly stratifying patients into distinct high- and low-risk DFS groups. Multimodal feature fusion consistently outperformed models based on single feature categories (clinical data, imaging, or radiomics alone), highlighting the synergistic value of integrating diverse data sources. By integrating multimodal data to predict DFS and recurrence risk, CerviPro provides a clinically valuable prognostic tool for LACC, offering the potential to guide personalized treatment strategies.

Adrenal incidentalomas (AIs) are predominantly adrenal adenomas (80%), with a smaller proportion (7%) being pheochromocytomas(PHEO). Adenomas are typically non-functional tumors managed through observation or medication, with some cases requiring surgical removal, which is generally safe. In contrast, PHEO secrete catecholamines, causing severe blood pressure fluctuations, making surgical resection the only treatment option. Without adequate preoperative preparation, perioperative mortality risk is significantly high.A specialized adrenal CT scanning protocol is recommended to differentiate between these tumor types. However, distinguishing patients with similar washout characteristics remains challenging, and concerns about efficiency, cost, and risk limit its feasibility. Recently, radiomics has demonstrated efficacy in identifying molecular-level differences in tumor cells, including adrenal tumors. This study develops a combined nomogram model, integrating key clinical-radiological and radiomic features from multiphase CT, to enhance accuracy in distinguishing pheochromocytoma from large-diameter lipid-poor adrenal adenoma (LP-AA). A retrospective analysis was conducted on 202 patients with pathologically confirmed adrenal PHEO and large-diameter LP-AA from three tertiary care centers. Key clinico-radiological and radiomics features were selected to construct models: a clinico-radiological model, a radiomics model, and a combined nomogram model for predicting these two tumor types. Model performance and robustness were evaluated using external validation, calibration curve analysis, machine learning techniques, and Delong's test. Additionally, the Hosmer-Lemeshow test, decision curve analysis, and five-fold cross-validation were employed to assess the clinical translational potential of the combined nomogram model. All models demonstrated high diagnostic performance, with AUC values exceeding 0.8 across all cohorts, confirming their reliability. The combined nomogram model exhibited the highest diagnostic accuracy, with AUC values of 0.994, 0.979, and 0.945 for the training, validation, and external test cohorts, respectively. Notably, the unenhanced combined nomogram model was not significantly inferior to the three-phase combined nomogram model (p > 0.05 in the validation and test cohorts; p = 0.049 in the training cohort). The combined nomogram model reliably distinguishes between PHEO and LP-AA, shows strong clinical translational potential, and may reduce the need for contrast-enhanced CT scans. Not applicable.