Content-based mammographic image retrieval systems require exact BIRADS categorical matching across five distinct classes, presenting significantly greater complexity than binary classification tasks commonly addressed in literature. Current medical image retrieval studies suffer from methodological limitations including inadequate sample sizes, improper data splitting, and insufficient statistical validation that hinder clinical translation. We developed a comprehensive evaluation framework systematically comparing CNN architectures (DenseNet121, ResNet50, VGG16) with advanced training strategies including sophisticated fine-tuning, metric learning, and super-ensemble optimization. Our evaluation employed rigorous stratified data splitting (50%/20%/30% train/validation/test), 602 test queries, and systematic validation using bootstrap confidence intervals with 1,000 samples. Advanced fine-tuning with differential learning rates achieved substantial improvements: DenseNet121 (34.79% precision@10, 19.64% improvement) and ResNet50 (34.54%, 19.58% improvement). Super-ensemble optimization combining complementary architectures achieved 36.33% precision@10 (95% CI: [34.78%, 37.88%]), representing 24.93% improvement over baseline and providing 3.6 relevant cases per query. Statistical analysis revealed significant performance differences between optimization strategies (p<0.001) with large effect sizes (Cohen's d>0.8), while maintaining practical search efficiency (2.8milliseconds). Performance significantly exceeds realistic expectations for 5-class medical retrieval tasks, where literature suggests 20-25% precision@10 represents achievable performance for exact BIRADS matching. Our framework establishes new performance benchmarks while providing evidence-based architecture selection guidelines for clinical deployment in diagnostic support and quality assurance applications.

Medical imaging, particularly retinal fundus photography, plays a crucial role in early disease detection and treatment for various ocular disorders. However, the development of robust diagnostic systems using deep learning remains constrained by the scarcity of expertly annotated data, which is time-consuming and expensive. Self-Supervised Learning (SSL) has emerged as a promising solution, but existing models fail to effectively incorporate critical domain knowledge specific to retinal anatomy. This potentially limits their clinical relevance and diagnostic capability. We address this issue by introducing an anatomically aware SSL framework that strategically integrates domain expertise through specialized masking of vital retinal structures during pretraining. Our approach leverages vessel and optic disc segmentation maps to guide the SSL process, enabling the development of clinically relevant feature representations without extensive labeled data. The framework combines a Vision Transformer with dual-masking strategies and anatomically informed loss functions to preserve structural integrity during feature learning. Comprehensive evaluation across multiple datasets demonstrates our method's competitive performance in diverse retinal disease classification tasks, including diabetic retinopathy grading, glaucoma detection, age-related macular degeneration identification, and multi-disease classification. The evaluation results establish the effectiveness of anatomically-aware SSL in advancing automated retinal disease diagnosis while addressing the fundamental challenge of limited labeled medical data.

Interstitial lung disease (ILD) prognostication incorporates clinical history, pulmonary function testing (PFTs), and chest CT pattern classifications. The machine learning classifier, Fibresolve, includes a model to help detect CT patterns associated with idiopathic pulmonary fibrosis (IPF). We developed and tested new Fibresolve software to predict outcomes in patients with ILD. Fibresolve uses a transformer (ViT) algorithm to analyze CT imaging that additionally embeds PFTs, age, and sex to produce an overall risk score. The model was trained to optimize risk score in a dataset of 602 subjects designed to maximize predictive performance via Cox proportional hazards. Validation was completed with the first hazard ratio assessment dataset, then tested in a second datatest set. 61 % of 220 subjects died in the validation set's study period, whereas 40 % of the 407 subjects died in the second dataset's. The validation dataset's mortality hazard ratio (HR) was 3.66 (95 % CI: 2.09-6.42) and 4.66 (CI: 2.47-8.77) for the moderate and high-risk groups. In the second dataset, Fibresolve was a predictor of mortality at initial visit, with a HR of 2.79 (1.73-4.49) and 5.82 (3.53-9.60) in the moderate and high-risk groups. Similar predictive performance was seen at follow-up visits, as well as with changes in the Fibresolve scores over sequential visits. Fibresolve predicts mortality by automatically assessing combined CT, PFTs, age, and sex into a ViT model. The new software algorithm affords accurate prognostication and demonstrates the ability to detect clinical changes over time.

Automated segmentation of multiple sclerosis (MS) lesions using multicontrast magnetic resonance (MR) images improves efficiency and reproducibility compared to manual delineation, with deep learning (DL) methods achieving state-of-the-art performance. However, these DL-based methods have yet to simultaneously optimize in-domain accuracy and out-of-domain generalization when trained on a single source with limited data, or their performance has been unsatisfactory. To fill this gap, we propose a method called UNISELF, which achieves high accuracy within a single training domain while demonstrating strong generalizability across multiple out-of-domain test datasets. UNISELF employs a novel test-time self-ensembled lesion fusion to improve segmentation accuracy, and leverages test-time instance normalization (TTIN) of latent features to address domain shifts and missing input contrasts. Trained on the ISBI 2015 longitudinal MS segmentation challenge training dataset, UNISELF ranks among the best-performing methods on the challenge test dataset. Additionally, UNISELF outperforms all benchmark methods trained on the same ISBI training data across diverse out-of-domain test datasets with domain shifts and missing contrasts, including the public MICCAI 2016 and UMCL datasets, as well as a private multisite dataset. These test datasets exhibit domain shifts and/or missing contrasts caused by variations in acquisition protocols, scanner types, and imaging artifacts arising from imperfect acquisition. Our code is available at https://github.com/uponacceptance.

Conventional approaches to material decomposition in spectral CT face challenges related to precise algorithm calibration across imaged conditions and low signal quality caused by variable object size and reduced dose. In this proof-of-principle study, a deep learning approach to multi-material decomposition was developed to quantify iodine, gadolinium, and calcium in spectral CT. A dual-phase network architecture was trained using synthetic datasets containing computational models of cylindrical and virtual patient phantoms. Classification and quantification performance was evaluated across a range of patient size and dose parameters. The model was found to accurately classify (accuracy: cylinders - 98%, virtual patients - 97%) and quantify materials (mean absolute percentage difference: cylinders - 8-10%, virtual patients - 10-15%) in both datasets. Performance in virtual patient phantoms improved as the hybrid training dataset included a larger contingent of virtual patient phantoms (accuracy: 48% with 0 virtual patients to 97% with 8 virtual patients). For both datasets, the algorithm was able to maintain strong performance under challenging conditions of large patient size and reduced dose. This study shows the validity of a deep-learning based approach to multi-material decomposition trained with in-silico images that can overcome the limitations of conventional material decomposition approaches.

Angle estimation is an important step in the Doppler ultrasound clinical workflow to measure blood velocity. It is widely recognized that incorrect angle estimation is a leading cause of error in Doppler-based blood velocity measurements. In this paper, we propose a deep learning-based approach for automated Doppler angle estimation. The approach was developed using 2100 human carotid ultrasound images including image augmentation. Five pre-trained models were used to extract images features, and these features were passed to a custom shallow network for Doppler angle estimation. Independently, measurements were obtained by a human observer reviewing the images for comparison. The mean absolute error (MAE) between the automated and manual angle estimates ranged from 3.9{\deg} to 9.4{\deg} for the models evaluated. Furthermore, the MAE for the best performing model was less than the acceptable clinical Doppler angle error threshold thus avoiding misclassification of normal velocity values as a stenosis. The results demonstrate potential for applying a deep-learning based technique for automated ultrasound Doppler angle estimation. Such a technique could potentially be implemented within the imaging software on commercial ultrasound scanners.

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.

In recent years, transformer-based methods have achieved remarkable progress in medical image segmentation due to their superior ability to capture long-range dependencies. However, these methods typically suffer from two major limitations. First, their computational complexity scales quadratically with the input sequences. Second, the feed-forward network (FFN) modules in vanilla Transformers typically rely on fully connected layers, which limits models' ability to capture local contextual information and multiscale features critical for precise semantic segmentation. To address these issues, we propose an efficient medical image segmentation network, named TCSAFormer. The proposed TCSAFormer adopts two key ideas. First, it incorporates a Compressed Attention (CA) module, which combines token compression and pixel-level sparse attention to dynamically focus on the most relevant key-value pairs for each query. This is achieved by pruning globally irrelevant tokens and merging redundant ones, significantly reducing computational complexity while enhancing the model's ability to capture relationships between tokens. Second, it introduces a Dual-Branch Feed-Forward Network (DBFFN) module as a replacement for the standard FFN to capture local contextual features and multiscale information, thereby strengthening the model's feature representation capability. We conduct extensive experiments on three publicly available medical image segmentation datasets: ISIC-2018, CVC-ClinicDB, and Synapse, to evaluate the segmentation performance of TCSAFormer. Experimental results demonstrate that TCSAFormer achieves superior performance compared to existing state-of-the-art (SOTA) methods, while maintaining lower computational overhead, thus achieving an optimal trade-off between efficiency and accuracy.

This study aimed to evaluate the potential additional value of deep radiomics for assessing residual cancer burden (RCB) in locally advanced breast cancer, after neoadjuvant chemotherapy (NAC) but before surgery, compared to standard predictors: tumor volume and subtype. This retrospective study used a 105-patient single-institution training set and a 41-patient external test set from three institutions in the LIMA trial. DCE-MRI was performed before and after NAC, and RCB was determined post-surgery. Three networks (nnU-Net, Attention U-net and vector-quantized encoder-decoder) were trained for tumor segmentation. For each network, deep features were extracted from the bottleneck layer and used to train random forest regression models to predict RCB score. Models were compared to (1) a model trained on tumor volume and (2) a model combining tumor volume and subtype. The potential complementary performance of combining deep radiomics with a clinical-radiological model was assessed. From the predicted RCB score, three metrics were calculated: area under the curve (AUC) for categories RCB-0/RCB-I versus RCB-II/III, pathological complete response (pCR) versus non-pCR, and Spearman's correlation. Deep radiomics models had an AUC between 0.68-0.74 for pCR and 0.68-0.79 for RCB, while the volume-only model had an AUC of 0.74 and 0.70 for pCR and RCB, respectively. Spearman's correlation varied from 0.45-0.51 (deep radiomics) to 0.53 (combined model). No statistical difference between models was observed. Segmentation network-derived deep radiomics contain similar information to tumor volume and subtype for inferring pCR and RCB after NAC, but do not complement standard clinical predictors in the LIMA trial. Question It is unknown if and which deep radiomics approach is most suitable to extract relevant features to assess neoadjuvant chemotherapy response on breast MRI. Findings Radiomic features extracted from deep-learning networks yield similar results in predicting neoadjuvant chemotherapy response as tumor volume and subtype in the LIMA study. However, they do not provide complementary information. Clinical relevance For predicting response to neoadjuvant chemotherapy in breast cancer patients, tumor volume on MRI and subtype remain important predictors of treatment outcome; deep radiomics might be an alternative when determining tumor volume and/or subtype is not feasible.

Magnetic Resonance Imaging (MRI) is widely utilized in medical imaging due to its high resolution and non-invasive nature. However, the prolonged acquisition time significantly limits its clinical applicability. Although traditional compressed sensing (CS) techniques can accelerate MRI acquisition, they often lead to degraded reconstruction quality under high undersampling rates. Deep learning-based methods, including CNN- and GAN-based approaches, have improved reconstruction performance, yet are limited by their local receptive fields, making it challenging to effectively capture long-range dependencies. Moreover, these models typically exhibit high computational complexity, which hinders their efficient deployment in practical scenarios. To address these challenges, we propose a lightweight Multi-scale Context-Aware Generative Adversarial Network (MCA-GAN), which enhances MRI reconstruction through dual-domain generators that collaboratively optimize both k-space and image-domain representations. MCA-GAN integrates several lightweight modules, including Depthwise Separable Local Attention (DWLA) for efficient local feature extraction, Adaptive Group Rearrangement Block (AGRB) for dynamic inter-group feature optimization, Multi-Scale Spatial Context Modulation Bridge (MSCMB) for multi-scale feature fusion in skip connections, and Channel-Spatial Multi-Scale Self-Attention (CSMS) for improved global context modeling. Extensive experiments conducted on the IXI, MICCAI 2013, and MRNet knee datasets demonstrate that MCA-GAN consistently outperforms existing methods in terms of PSNR and SSIM. Compared to SepGAN, the latest lightweight model, MCA-GAN achieves a 27.3% reduction in parameter size and a 19.6% reduction in computational complexity, while attaining the shortest reconstruction time among all compared methods. Furthermore, MCA-GAN exhibits robust performance across various undersampling masks and acceleration rates. Cross-dataset generalization experiments further confirm its ability to maintain competitive reconstruction quality, underscoring its strong generalization potential. Overall, MCA-GAN improves MRI reconstruction quality while significantly reducing computational cost through a lightweight architecture and multi-scale feature fusion, offering an efficient and accurate solution for accelerated MRI.