To evaluate the effectiveness of open-weight large language models (LLMs) in extracting key radiological features and determining National Comprehensive Cancer Network (NCCN) resectability status from free-text radiology reports for pancreatic ductal adenocarcinoma (PDAC). Methods. Prompts were developed using 30 fictitious reports, internally validated on 100 additional fictitious reports, and tested using 200 real reports from two institutions (January 2022 to December 2023). Two radiologists established ground truth for 18 key features and resectability status. Gemma-2-27b-it and Llama-3-70b-instruct models were evaluated using recall, precision, F1-score, extraction accuracy, and overall resectability accuracy. Statistical analyses included McNemar's test and mixed-effects logistic regression. Results. In internal validation, Llama had significantly higher recall than Gemma (99% vs. 95%, p < 0.01) and slightly higher extraction accuracy (98% vs. 97%). Llama also demonstrated higher overall resectability accuracy (93% vs. 91%). In the internal test set, both models achieved 96% recall and 96% extraction accuracy. Overall resectability accuracy was 95% for Llama and 93% for Gemma. In the external test set, both models had 93% recall. Extraction accuracy was 93% for Llama and 95% for Gemma. Gemma achieved higher overall resectability accuracy (89% vs. 83%), but the difference was not statistically significant (p > 0.05). Conclusion. Open-weight models accurately extracted key radiological features and determined NCCN resectability status from free-text PDAC reports. While internal dataset performance was robust, performance on external data decreased, highlighting the need for institution-specific optimization.

Osteoarthritis (OA) pain often does not correlate with magnetic resonance imaging (MRI)-detected structural abnormalities, limiting the clinical utility of traditional volume-based lesion assessments. To address this mismatch, we present a novel explainable artificial intelligence (XAI) framework that localizes pain-driving abnormalities in knee MR images via counterfactual image synthesis and Shapley-based feature attribution. Our method combines a Bayesian generative network-which is trained to synthesize asymptomatic versions of symptomatic knees-with a black-box pain classifier to generate counterfactual MRI scans. These counterfactuals, which are constrained by multimodal segmentation and uncertainty-aware inference, isolate lesion regions that are likely responsible for symptoms. Applying Shapley additive explanations (SHAP) to the output of the classifier enables the contribution of each lesion to pain to be precisely quantified. We trained and validated this framework on 2148 knee pairs obtained from a multicenter study of the Osteoarthritis Initiative (OAI), achieving high anatomical specificity in terms of identifying pain-relevant features such as patellar effusions and bone marrow lesions. An odds ratio (OR) analysis revealed that SHAP-derived lesion scores were significantly more strongly associated with pain than raw lesion volumes were (OR 6.75 vs. 3.73 in patellar regions), supporting the interpretability and clinical relevance of the model. Compared with conventional saliency methods and volumetric measures, our approach demonstrates superior lesion-level resolution and highlights the spatial heterogeneity of OA pain mechanisms. These results establish a new direction for conducting interpretable, lesion-specific MRI analyses that could guide personalized treatment strategies for musculoskeletal disorders.

While the primary goal of lung cancer screening CT is to detect early-stage lung cancer in high-risk populations, it often reveals asymptomatic cardiovascular abnormalities that can be clinically significant. These findings include coronary artery calcifications (CACs), myocardial pathologies, cardiac chamber enlargement, valvular lesions, and vascular disease. CAC, a marker of subclinical atherosclerosis, is particularly emphasized due to its strong predictive value for cardiovascular events and mortality. Guidelines recommend qualitative or quantitative CAC scoring on all noncontrast chest CTs. Other actionable findings include aortic aneurysms, pericardial disease, and myocardial pathology, some of which may indicate past or impending cardiac events. This article explores the wide range of incidental cardiovascular findings detectable during low-dose CT (LDCT) scans for lung cancer screening, as well as noncontrast chest CT scans. Distinguishing which findings warrant further evaluation is essential to avoid overdiagnosis, unnecessary anxiety, and resource misuse. The article advocates for a structured approach to follow-up based on the clinical significance of each finding and the patient's overall risk profile. It also notes the rising role of artificial intelligence in automatically detecting and quantifying these abnormalities, potentiating early behavioral modification or medical and surgical interventions. Ultimately, this piece highlights the opportunity to reframe LDCT as a comprehensive cardiothoracic screening tool.

Managing scan protocols in Computed Tomography (CT), which includes adjusting acquisition parameters or configuring reconstructions, as well as selecting postprocessing tools in a patient-specific manner, is time-consuming and requires clinical as well as technical expertise. At the same time, we observe an increasing shortage of skilled workforce in radiology. To address this issue, a Large Language Model (LLM)-based agent framework is proposed to assist with the interpretation and execution of protocol configuration requests given in natural language or a structured, device-independent format, aiming to improve the workflow efficiency and reduce technologists' workload. The agent combines in-context-learning, instruction-following, and structured toolcalling abilities to identify relevant protocol elements and apply accurate modifications. In a systematic evaluation, experimental results indicate that the agent can effectively retrieve protocol components, generate device compatible protocol definition files, and faithfully implement user requests. Despite demonstrating feasibility in principle, the approach faces limitations regarding syntactic and semantic validity due to lack of a unified device API, and challenges with ambiguous or complex requests. In summary, the findings show a clear path towards LLM-based agents for supporting scan protocol management in CT imaging.

Serological screening, endoscopic imaging, morphological visual verification of precancerous gastric diseases and changes in the gastric mucosa are the main stages of early detection, accurate diagnosis and preventive treatment of gastric precancer. Laboratory - serological, endoscopic and histological diagnostics are carried out by medical laboratory technicians, endoscopists, and histologists. Human factors have a very large share of subjectivity. Endoscopists and histologists are guided by the descriptive principle when formulating imaging conclusions. Diagnostic reports from doctors often result in contradictory and mutually exclusive conclusions. Erroneous results of diagnosticians and clinicians have fatal consequences, such as late diagnosis of gastric cancer and high mortality of patients. Effective population serological screening is only possible with the use of machine processing of laboratory test results. Currently, it is possible to replace subjective imprecise description of endoscopic and histological images by a diagnostician with objective, highly sensitive and highly specific visual recognition using convolutional neural networks with deep machine learning. There are many machine learning models to use. All machine learning models have predictive capabilities. Based on predictive models, it is necessary to identify the risk levels of gastric cancer in patients with a very high probability.

To assess the performance of state-of-the-art large language models in classifying vertebral metastasis stability using the Spinal Instability Neoplastic Score (SINS) compared to human experts, and to evaluate the impact of task-specific refinement including in-context learning on their performance. This retrospective study analyzed 100 synthetic CT and MRI reports encompassing a broad range of SINS scores. Four human experts (two radiologists and two neurosurgeons) and four large language models (Mistral, Claude, GPT-4 turbo, and GPT-4o) evaluated the reports. Large language models were tested in both generic form and with task-specific refinement. Performance was assessed based on correct SINS category assignment and attributed SINS points. Human experts demonstrated high median performance in SINS classification (98.5% correct) and points calculation (92% correct), with a median point offset of 0 [0-0]. Generic large language models performed poorly with 26-63% correct category and 4-15% correct SINS points allocation. In-context learning significantly improved chatbot performance to near-human levels (96-98/100 correct for classification, 86-95/100 for scoring, no significant difference to human experts). Refined large language models performed 71-85% better in SINS points allocation. In-context learning enables state-of-the-art large language models to perform at near-human expert levels in SINS classification, offering potential for automating vertebral metastasis stability assessment. The poor performance of generic large language models highlights the importance of task-specific refinement in medical applications of artificial intelligence.

Surgical navigation is a rapidly evolving multidisciplinary system that plays a crucial role in precision medicine. Surgical-navigation systems have substantially enhanced modern surgery by improving the precision of resection, reducing invasiveness, and enhancing patient outcomes. However, clinicians, engineers, and professionals in other fields often view this field from their own perspectives, which usually results in a one-sided viewpoint. This article aims to provide a thorough overview of the recent advancements in surgical-navigation systems and categorizes them on the basis of their unique characteristics and applications. Established techniques (e.g., radiography, intraoperative computed tomography [CT], magnetic resonance imaging [MRI], and ultrasound) and emerging technologies (e.g., photoacoustic imaging and near-infrared [NIR]-II imaging) are systematically analyzed, highlighting their underlying mechanisms, methods of use, and respective advantages and disadvantages. Despite substantial progress, the existing navigation systems face challenges, including limited accuracy, high costs, and extensive training requirements for surgeons. Addressing these limitations is crucial for widespread adoption of these technologies. The review emphasizes the need for developing more intelligent, minimally invasive, precise, personalized, and radiation-free navigation solutions. By integrating advanced imaging modalities, machine learning algorithms, and real-time feedback mechanisms, next-generation surgical-navigation systems can further enhance surgical precision and patient safety. By bridging the knowledge gap between clinical practice and engineering innovation, this review not only provides valuable insights for surgeons seeking optimal navigation strategies, but also offers engineers a deeper understanding of clinical application scenarios.

Medical imaging provides critical evidence for clinical diagnosis, treatment planning, and surgical decisions, yet most existing imaging models are narrowly focused and require multiple specialized networks, limiting their generalization. Although large-scale language and multimodal models exhibit strong reasoning and multi-task capabilities, real-world clinical applications demand precise visual grounding, multimodal integration, and chain-of-thought reasoning. We introduce Citrus-V, a multimodal medical foundation model that combines image analysis with textual reasoning. The model integrates detection, segmentation, and multimodal chain-of-thought reasoning, enabling pixel-level lesion localization, structured report generation, and physician-like diagnostic inference in a single framework. We propose a novel multimodal training approach and release a curated open-source data suite covering reasoning, detection, segmentation, and document understanding tasks. Evaluations demonstrate that Citrus-V outperforms existing open-source medical models and expert-level imaging systems across multiple benchmarks, delivering a unified pipeline from visual grounding to clinical reasoning and supporting precise lesion quantification, automated reporting, and reliable second opinions.

Neuroimaging is a ubiquitous tool for evaluating patients with neurological diseases. The global demand for magnetic resonance imaging (MRI) studies has risen steadily, placing significant strain on health systems, prolonging turnaround times, and intensifying physician burnout \cite{Chen2017-bt, Rula2024-qp-1}. These challenges disproportionately impact patients in low-resource and rural settings. Here, we utilized a large academic health system as a data engine to develop Prima, the first vision language model (VLM) serving as an AI foundation for neuroimaging that supports real-world, clinical MRI studies as input. Trained on over 220,000 MRI studies, Prima uses a hierarchical vision architecture that provides general and transferable MRI features. Prima was tested in a 1-year health system-wide study that included 30K MRI studies. Across 52 radiologic diagnoses from the major neurologic disorders, including neoplastic, inflammatory, infectious, and developmental lesions, Prima achieved a mean diagnostic area under the ROC curve of 92.0, outperforming other state-of-the-art general and medical AI models. Prima offers explainable differential diagnoses, worklist priority for radiologists, and clinical referral recommendations across diverse patient demographics and MRI systems. Prima demonstrates algorithmic fairness across sensitive groups and can help mitigate health system biases, such as prolonged turnaround times for low-resource populations. These findings highlight the transformative potential of health system-scale VLMs and Prima's role in advancing AI-driven healthcare.

Objective: Cone-beam computed tomography (CBCT) provides a low-dose imaging alternative to conventional CT, but suffers from noise, scatter, and artifacts that degrade image quality. Synthetic CT (sCT) aims to translate CBCT to high-quality CT-like images for improved anatomical accuracy and dosimetric precision. Although deep learning approaches have shown promise, they often face limitations in generalizability and detail preservation. Conditional diffusion models (CDMs), with their iterative refinement process, offers a novel solution. This review systematically examines the use of CDMs for CBCT-to-sCT synthesis. Methods: A systematic search was conducted in Web of Science, Scopus, and Google Scholar for studies published between 2013 and 2024. Inclusion criteria targeted works employing conditional diffusion models specifically for sCT generation. Eleven relevant studies were identified and analyzed to address three questions: (1) What conditional diffusion methods are used? (2) How do they compare to conventional deep learning in accuracy? (3) What are their clinical implications? Results: CDMs incorporating anatomical priors and spatial-frequency features demonstrated improved structural preservation and noise robustness. Energy-guided and hybrid latent models enabled enhanced dosimetric accuracy and personalized image synthesis. Across studies, CDMs consistently outperformed traditional deep learning models in noise suppression and artefact reduction, especially in challenging cases like lung imaging and dual-energy CT. Conclusion: Conditional diffusion models show strong potential for generalized, accurate sCT generation from CBCT. However, clinical adoption remains limited. Future work should focus on scalability, real-time inference, and integration with multi-modal imaging to enhance clinical relevance.