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Beyond the First Read: AI-Assisted Perceptual Error Detection in Chest Radiography Accounting for Interobserver Variability

Adhrith Vutukuri, Akash Awasthi, David Yang, Carol C. Wu, Hien Van Nguyen

arxiv logopreprintJun 16 2025
Chest radiography is widely used in diagnostic imaging. However, perceptual errors -- especially overlooked but visible abnormalities -- remain common and clinically significant. Current workflows and AI systems provide limited support for detecting such errors after interpretation and often lack meaningful human--AI collaboration. We introduce RADAR (Radiologist--AI Diagnostic Assistance and Review), a post-interpretation companion system. RADAR ingests finalized radiologist annotations and CXR images, then performs regional-level analysis to detect and refer potentially missed abnormal regions. The system supports a "second-look" workflow and offers suggested regions of interest (ROIs) rather than fixed labels to accommodate inter-observer variation. We evaluated RADAR on a simulated perceptual-error dataset derived from de-identified CXR cases, using F1 score and Intersection over Union (IoU) as primary metrics. RADAR achieved a recall of 0.78, precision of 0.44, and an F1 score of 0.56 in detecting missed abnormalities in the simulated perceptual-error dataset. Although precision is moderate, this reduces over-reliance on AI by encouraging radiologist oversight in human--AI collaboration. The median IoU was 0.78, with more than 90% of referrals exceeding 0.5 IoU, indicating accurate regional localization. RADAR effectively complements radiologist judgment, providing valuable post-read support for perceptual-error detection in CXR interpretation. Its flexible ROI suggestions and non-intrusive integration position it as a promising tool in real-world radiology workflows. To facilitate reproducibility and further evaluation, we release a fully open-source web implementation alongside a simulated error dataset. All code, data, demonstration videos, and the application are publicly available at https://github.com/avutukuri01/RADAR.

FDTooth: Intraoral Photographs and CBCT Images for Fenestration and Dehiscence Detection.

Liu K, Elbatel M, Chu G, Shan Z, Sum FHKMH, Hung KF, Zhang C, Li X, Yang Y

pubmed logopapersJun 14 2025
Fenestration and dehiscence (FD) pose significant challenges in dental treatments as they adversely affect oral health. Although cone-beam computed tomography (CBCT) provides precise diagnostics, its extensive time requirements and radiation exposure limit its routine use for monitoring. Currently, there is no public dataset that combines intraoral photographs and corresponding CBCT images; this limits the development of deep learning algorithms for the automated detection of FD and other potential diseases. In this paper, we present FDTooth, a dataset that includes both intraoral photographs and CBCT images of 241 patients aged between 9 and 55 years. FDTooth contains 1,800 precise bounding boxes annotated on intraoral photographs, with gold-standard ground truth extracted from CBCT. We developed a baseline model for automated FD detection in intraoral photographs. The developed dataset and model can serve as valuable resources for research on interdisciplinary dental diagnostics, offering clinicians a non-invasive, efficient method for early FD screening without invasive procedures.

BraTS orchestrator : Democratizing and Disseminating state-of-the-art brain tumor image analysis

Florian Kofler, Marcel Rosier, Mehdi Astaraki, Ujjwal Baid, Hendrik Möller, Josef A. Buchner, Felix Steinbauer, Eva Oswald, Ezequiel de la Rosa, Ivan Ezhov, Constantin von See, Jan Kirschke, Anton Schmick, Sarthak Pati, Akis Linardos, Carla Pitarch, Sanyukta Adap, Jeffrey Rudie, Maria Correia de Verdier, Rachit Saluja, Evan Calabrese, Dominic LaBella, Mariam Aboian, Ahmed W. Moawad, Nazanin Maleki, Udunna Anazodo, Maruf Adewole, Marius George Linguraru, Anahita Fathi Kazerooni, Zhifan Jiang, Gian Marco Conte, Hongwei Li, Juan Eugenio Iglesias, Spyridon Bakas, Benedikt Wiestler, Marie Piraud, Bjoern Menze

arxiv logopreprintJun 13 2025
The Brain Tumor Segmentation (BraTS) cluster of challenges has significantly advanced brain tumor image analysis by providing large, curated datasets and addressing clinically relevant tasks. However, despite its success and popularity, algorithms and models developed through BraTS have seen limited adoption in both scientific and clinical communities. To accelerate their dissemination, we introduce BraTS orchestrator, an open-source Python package that provides seamless access to state-of-the-art segmentation and synthesis algorithms for diverse brain tumors from the BraTS challenge ecosystem. Available on GitHub (https://github.com/BrainLesion/BraTS), the package features intuitive tutorials designed for users with minimal programming experience, enabling both researchers and clinicians to easily deploy winning BraTS algorithms for inference. By abstracting the complexities of modern deep learning, BraTS orchestrator democratizes access to the specialized knowledge developed within the BraTS community, making these advances readily available to broader neuro-radiology and neuro-oncology audiences.

BreastDCEDL: Curating a Comprehensive DCE-MRI Dataset and developing a Transformer Implementation for Breast Cancer Treatment Response Prediction

Naomi Fridman, Bubby Solway, Tomer Fridman, Itamar Barnea, Anat Goldshtein

arxiv logopreprintJun 13 2025
Breast cancer remains a leading cause of cancer-related mortality worldwide, making early detection and accurate treatment response monitoring critical priorities. We present BreastDCEDL, a curated, deep learning-ready dataset comprising pre-treatment 3D Dynamic Contrast-Enhanced MRI (DCE-MRI) scans from 2,070 breast cancer patients drawn from the I-SPY1, I-SPY2, and Duke cohorts, all sourced from The Cancer Imaging Archive. The raw DICOM imaging data were rigorously converted into standardized 3D NIfTI volumes with preserved signal integrity, accompanied by unified tumor annotations and harmonized clinical metadata including pathologic complete response (pCR), hormone receptor (HR), and HER2 status. Although DCE-MRI provides essential diagnostic information and deep learning offers tremendous potential for analyzing such complex data, progress has been limited by lack of accessible, public, multicenter datasets. BreastDCEDL addresses this gap by enabling development of advanced models, including state-of-the-art transformer architectures that require substantial training data. To demonstrate its capacity for robust modeling, we developed the first transformer-based model for breast DCE-MRI, leveraging Vision Transformer (ViT) architecture trained on RGB-fused images from three contrast phases (pre-contrast, early post-contrast, and late post-contrast). Our ViT model achieved state-of-the-art pCR prediction performance in HR+/HER2- patients (AUC 0.94, accuracy 0.93). BreastDCEDL includes predefined benchmark splits, offering a framework for reproducible research and enabling clinically meaningful modeling in breast cancer imaging.

Enhancing Privacy: The Utility of Stand-Alone Synthetic CT and MRI for Tumor and Bone Segmentation

André Ferreira, Kunpeng Xie, Caroline Wilpert, Gustavo Correia, Felix Barajas Ordonez, Tiago Gil Oliveira, Maike Bode, Robert Siepmann, Frank Hölzle, Rainer Röhrig, Jens Kleesiek, Daniel Truhn, Jan Egger, Victor Alves, Behrus Puladi

arxiv logopreprintJun 13 2025
AI requires extensive datasets, while medical data is subject to high data protection. Anonymization is essential, but poses a challenge for some regions, such as the head, as identifying structures overlap with regions of clinical interest. Synthetic data offers a potential solution, but studies often lack rigorous evaluation of realism and utility. Therefore, we investigate to what extent synthetic data can replace real data in segmentation tasks. We employed head and neck cancer CT scans and brain glioma MRI scans from two large datasets. Synthetic data were generated using generative adversarial networks and diffusion models. We evaluated the quality of the synthetic data using MAE, MS-SSIM, Radiomics and a Visual Turing Test (VTT) performed by 5 radiologists and their usefulness in segmentation tasks using DSC. Radiomics indicates high fidelity of synthetic MRIs, but fall short in producing highly realistic CT tissue, with correlation coefficient of 0.8784 and 0.5461 for MRI and CT tumors, respectively. DSC results indicate limited utility of synthetic data: tumor segmentation achieved DSC=0.064 on CT and 0.834 on MRI, while bone segmentation a mean DSC=0.841. Relation between DSC and correlation is observed, but is limited by the complexity of the task. VTT results show synthetic CTs' utility, but with limited educational applications. Synthetic data can be used independently for the segmentation task, although limited by the complexity of the structures to segment. Advancing generative models to better tolerate heterogeneous inputs and learn subtle details is essential for enhancing their realism and expanding their application potential.

Summary Report of the SNMMI AI Task Force Radiomics Challenge 2024.

Boellaard R, Rahmim A, Eertink JJ, Duehrsen U, Kurch L, Lugtenburg PJ, Wiegers SE, Zwezerijnen GJC, Zijlstra JM, Heymans MW, Buvat I

pubmed logopapersJun 12 2025
In medical imaging, challenges are competitions that aim to provide a fair comparison of different methodologic solutions to a common problem. Challenges typically focus on addressing real-world problems, such as segmentation, detection, and prediction tasks, using various types of medical images and associated data. Here, we describe the organization and results of such a challenge to compare machine-learning models for predicting survival in patients with diffuse large B-cell lymphoma using a baseline <sup>18</sup>F-FDG PET/CT radiomics dataset. <b>Methods:</b> This challenge aimed to predict progression-free survival (PFS) in patients with diffuse large B-cell lymphoma, either as a binary outcome (shorter than 2 y versus longer than 2 y) or as a continuous outcome (survival in months). All participants were provided with a radiomic training dataset, including the ground truth survival for designing a predictive model and a radiomic test dataset without ground truth. Figures of merit (FOMs) used to assess model performance were the root-mean-square error for continuous outcomes and the C-index for 1-, 2-, and 3-y PFS binary outcomes. The challenge was endorsed and initiated by the Society of Nuclear Medicine and Molecular Imaging AI Task Force. <b>Results:</b> Nineteen models for predicting PFS as a continuous outcome from 15 teams were received. Among those models, external validation identified 6 models showing similar performance to that of a simple general linear reference model using SUV and total metabolic tumor volumes (TMTV) only. Twelve models for predicting binary outcomes were submitted by 9 teams. External validation showed that 1 model had higher, but nonsignificant, C-index values compared with values obtained by a simple logistic regression model using SUV and TMTV. <b>Conclusion:</b> Some of the radiomic-based machine-learning models developed by participants showed better FOMs than did simple linear or logistic regression models based on SUV and TMTV only, although the differences in observed FOMs were nonsignificant. This suggests that, for the challenge dataset, there was limited or no value seen from the addition of sophisticated radiomic features and use of machine learning when developing models for outcome prediction.

MedSeg-R: Reasoning Segmentation in Medical Images with Multimodal Large Language Models

Yu Huang, Zelin Peng, Yichen Zhao, Piao Yang, Xiaokang Yang, Wei Shen

arxiv logopreprintJun 12 2025
Medical image segmentation is crucial for clinical diagnosis, yet existing models are limited by their reliance on explicit human instructions and lack the active reasoning capabilities to understand complex clinical questions. While recent advancements in multimodal large language models (MLLMs) have improved medical question-answering (QA) tasks, most methods struggle to generate precise segmentation masks, limiting their application in automatic medical diagnosis. In this paper, we introduce medical image reasoning segmentation, a novel task that aims to generate segmentation masks based on complex and implicit medical instructions. To address this, we propose MedSeg-R, an end-to-end framework that leverages the reasoning abilities of MLLMs to interpret clinical questions while also capable of producing corresponding precise segmentation masks for medical images. It is built on two core components: 1) a global context understanding module that interprets images and comprehends complex medical instructions to generate multi-modal intermediate tokens, and 2) a pixel-level grounding module that decodes these tokens to produce precise segmentation masks and textual responses. Furthermore, we introduce MedSeg-QA, a large-scale dataset tailored for the medical image reasoning segmentation task. It includes over 10,000 image-mask pairs and multi-turn conversations, automatically annotated using large language models and refined through physician reviews. Experiments show MedSeg-R's superior performance across several benchmarks, achieving high segmentation accuracy and enabling interpretable textual analysis of medical images.

SWDL: Stratum-Wise Difference Learning with Deep Laplacian Pyramid for Semi-Supervised 3D Intracranial Hemorrhage Segmentation

Cheng Wang, Siqi Chen, Donghua Mi, Yang Chen, Yudong Zhang, Yinsheng Li

arxiv logopreprintJun 12 2025
Recent advances in medical imaging have established deep learning-based segmentation as the predominant approach, though it typically requires large amounts of manually annotated data. However, obtaining annotations for intracranial hemorrhage (ICH) remains particularly challenging due to the tedious and costly labeling process. Semi-supervised learning (SSL) has emerged as a promising solution to address the scarcity of labeled data, especially in volumetric medical image segmentation. Unlike conventional SSL methods that primarily focus on high-confidence pseudo-labels or consistency regularization, we propose SWDL-Net, a novel SSL framework that exploits the complementary advantages of Laplacian pyramid and deep convolutional upsampling. The Laplacian pyramid excels at edge sharpening, while deep convolutions enhance detail precision through flexible feature mapping. Our framework achieves superior segmentation of lesion details and boundaries through a difference learning mechanism that effectively integrates these complementary approaches. Extensive experiments on a 271-case ICH dataset and public benchmarks demonstrate that SWDL-Net outperforms current state-of-the-art methods in scenarios with only 2% labeled data. Additional evaluations on the publicly available Brain Hemorrhage Segmentation Dataset (BHSD) with 5% labeled data further confirm the superiority of our approach. Code and data have been released at https://github.com/SIAT-CT-LAB/SWDL.

NeuroEmo: A neuroimaging-based fMRI dataset to extract temporal affective brain dynamics for Indian movie video clips stimuli using dynamic functional connectivity approach with graph convolution neural network (DFC-GCNN).

Abgeena A, Garg S, Goyal N, P C JR

pubmed logopapersJun 12 2025
FMRI, a non-invasive neuroimaging technique, can detect emotional brain activation patterns. It allows researchers to observe functional changes in the brain, making it a valuable tool for emotion recognition. For improved emotion recognition systems, it becomes crucial to understand the neural mechanisms behind emotional processing in the brain. There have been multiple studies across the world on the same, however, research on fMRI-based emotion recognition within the Indian population remains scarce, limiting the generalizability of existing models. To address this gap, a culturally relevant neuroimaging dataset has been created https://openneuro.org/datasets/ds005700 for identifying five emotional states i.e., calm, afraid, delighted, depressed and excited-in a diverse group of Indian participants. To ensure cultural relevance, emotional stimuli were derived from Bollywood movie clips. This study outlines the fMRI task design, experimental setup, data collection procedures, preprocessing steps, statistical analysis using the General Linear Model (GLM), and region-of-interest (ROI)-based dynamic functional connectivity (DFC) extraction using parcellation based on the Power et al. (2011) functional atlas. A supervised emotion classification model has been proposed using a Graph Convolutional Neural Network (GCNN), where graph structures were constructed from DFC matrices at varying thresholds. The DFC-GCNN model achieved an impressive 95% classification accuracy across 5-fold cross-validation, highlighting emotion-specific connectivity dynamics in key affective regions, including the amygdala, prefrontal cortex, and anterior insula. These findings emphasize the significance of temporal variability in emotional state classification. By introducing a culturally specific neuroimaging dataset and a GCNN-based emotion recognition framework, this research enhances the applicability of graph-based models for identifying region-wise connectivity patterns in fMRI data. It also offers novel insights into cross-cultural differences in emotional processing at the neural level. Furthermore, the high spatial and temporal resolution of the fMRI dataset provides a valuable resource for future studies in emotional neuroscience and related disciplines.

A fully open AI foundation model applied to chest radiography.

Ma D, Pang J, Gotway MB, Liang J

pubmed logopapersJun 11 2025
Chest radiography frequently serves as baseline imaging for most lung diseases<sup>1</sup>. Deep learning has great potential for automating the interpretation of chest radiography<sup>2</sup>. However, existing chest radiographic deep learning models are limited in diagnostic scope, generalizability, adaptability, robustness and extensibility. To overcome these limitations, we have developed Ark<sup>+</sup>, a foundation model applied to chest radiography and pretrained by cyclically accruing and reusing the knowledge from heterogeneous expert labels in numerous datasets. Ark<sup>+</sup> excels in diagnosing thoracic diseases. It expands the diagnostic scope and addresses potential misdiagnosis. It can adapt to evolving diagnostic needs and respond to novel diseases. It can learn rare conditions from a few samples and transfer to new diagnostic settings without training. It tolerates data biases and long-tailed distributions, and it supports federated learning to preserve privacy. All codes and pretrained models have been released, so that Ark<sup>+</sup> is open for fine-tuning, local adaptation and improvement. It is extensible to several modalities. Thus, it is a foundation model for medical imaging. The exceptional capabilities of Ark<sup>+</sup> stem from our insight: aggregating various datasets diversifies the patient populations and accrues knowledge from many experts to yield unprecedented performance while reducing annotation costs<sup>3</sup>. The development of Ark<sup>+</sup> reveals that open models trained by accruing and reusing knowledge from heterogeneous expert annotations with a multitude of public (big or small) datasets can surpass the performance of proprietary models trained on large data. We hope that our findings will inspire more researchers to share code and datasets or federate privacy-preserving data to create open foundation models with diverse, global expertise and patient populations, thus accelerating open science and democratizing AI for medicine.
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