The integration of artificial intelligence (AI) into healthcare is transforming clinical decision-making, patient outcomes, and workflows. AI inference, applying trained models to new data, is central to this evolution, with cloud-based infrastructures enabling scalable AI deployment. The Open Medical Inference (OMI) platform democratizes AI access through open protocols and standardized data formats for seamless, interoperable healthcare data exchange. By integrating standards like FHIR and DICOMweb, OMI ensures interoperability between healthcare institutions and AI services while fostering ethical AI use through a governance framework addressing privacy, transparency, and fairness.OMI's implementation is structured into work packages, each addressing technical and ethical aspects. These include expanding the Medical Informatics Initiative (MII) Core Dataset for medical imaging, developing infrastructure for AI inference, and creating an open-source DICOMweb adapter for legacy systems. Standardized data formats ensure interoperability, while the AI Governance Framework promotes trust and responsible AI use.The project aims to establish an interoperable AI network across healthcare institutions, connecting existing infrastructures and AI services to enhance clinical outcomes. · OMI develops open protocols and standardized data formats for seamless healthcare data exchange.. · Integration with FHIR and DICOMweb ensures interoperability between healthcare systems and AI services.. · A governance framework addresses privacy, transparency, and fairness in AI usage.. · Work packages focus on expanding datasets, creating infrastructure, and enabling legacy system integration.. · The project aims to create a scalable, secure, and interoperable AI network in healthcare.. · Pelka O, Sigle S, Werner P et al. Democratizing AI in Healthcare with Open Medical Inference (OMI): Protocols, Data Exchange, and AI Integration. Rofo 2025; DOI 10.1055/a-2651-6653.

Cancer is a leading, highly complex, and deadly disease that has become a major concern in modern medicine. Hepatocellular carcinoma is the most common primary liver cancer and a leading cause of global cancer mortality. Its development is predominantly associated with chronic liver diseases such as hepatitis B and C infections, cirrhosis, alcohol consumption, and non-alcoholic fatty liver disease. Molecular mechanisms underlying HCC involve genetic mutations, epigenetic changes, and disrupted signalling pathways, including Wnt/β-catenin and PI3K/AKT/mTOR. Early diagnosis remains challenging, as most cases are detected at advanced stages, limiting curative treatment options. Diagnostic advancements, including biomarkers like alpha-fetoprotein and cutting-edge imaging techniques such as CT, MRI, and ultrasound-based radiomics, have improved early detection. Treatment strategies depend on the disease stage, ranging from curative options like surgical resection and liver transplantation to palliative therapies, including transarterial chemoembolization, systemic therapies, and immunotherapy. Immune checkpoint inhibitors targeting PD-1/PD-L1 and CTLA-4 have shown promise for advanced HCC. In this review we discuss about emerging technologies, including artificial intelligence and multi-omics platforms for HCC management by enhancing diagnostic accuracy, identifying novel therapeutic targets, and enabling personalized treatments. Despite these advancements, the prognosis for HCC patients remains poor, underscoring the need for continued research into early detection, innovative therapies, and translational applications to effectively address this global health challenge.

To develop and validate radiomics and deep learning models based on Gd-EOB-DTPA enhanced MRI for differentiation between hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) showing iso- or hyperintensity in the hepatobiliary phase (HBP). 112 patients from three hospitals were collected totally. 84 patients from hospital a and b with 54 HCCs and 30 FNHs randomly divided into a training cohort (<i>n</i> = 59: 38 HCC; 21 FNH) and an internal validation cohort (<i>n</i> = 25: 16 HCC; 9 FNH). A total of 28 patients from hospital c (<i>n</i> = 28: 20 HCC; 8 FNH) acted as an external test cohort. 1781 radiomics features were extracted from tumor volumes of interest (VOIs) in the pre-contrast phase (Pre), arterial phase (AP), portal venous phase (PP) and HBP images. 512 deep learning features were extracted from VOIs in the AP, PP and HBP images. Pearson correlation coefficient (PCC) and analysis of variance (ANOVA) were used to select the useful features. Conventional, delta radiomics and deep learning models were established using machine learning algorithms (support vector machine [SVM] and logistic regression [LR]) and their discriminatory efficacy assessed and compared. The combined deep learning models demonstrated the highest diagnostic performance in both the internal validation and external test cohorts, with area under the curve (AUC) values of 0.965 (95% confidence interval [CI]: 0.906, 1.000) and 0.851 (95% CI: 0.620, 1.000) respectively. The conventional and delta radiomics models achieved AUCs of 0.944 (95% CI: 0.779–0.979) and 0.938 (95% CI: 0.836–1.000) respectively, which were not significantly different from the deep learning models or each other (<i>P</i> = 0.559, 0.256, and 0.137). The combined deep learning models based on Gd-EOB-DTPA enhanced MRI may be useful for discriminating HCC from FNH showing iso-or hyperintensity in the HBP. The online version contains supplementary material available at 10.1186/s12880-025-01927-3.

Precise confidence estimation in deep learning is vital for high-stakes fields like medical imaging, where overconfident misclassifications can have serious consequences. This work evaluates the effectiveness of Temperature Scaling (TS), a post-hoc calibration technique, in improving the reliability of convolutional neural networks (CNNs) for brain tumor classification. We develop a custom CNN and train it on a merged brain MRI dataset. To simulate real-world uncertainty, five types of image noise are introduced: Gaussian, Poisson, Salt & Pepper, Speckle, and Uniform. Model performance is evaluated using precision, recall, F1-score, accuracy, negative log-likelihood (NLL), and expected calibration error (ECE), both before and after calibration. Results demonstrate that TS significantly reduces ECE and NLL under all noise conditions without degrading classification accuracy. This underscores TS as an effective and computationally efficient approach to enhance decision confidence of medical AI systems, hence making model outputs more reliable in noisy or uncertain settings.

An anterior cruciate ligament (ACL) tear is a prevalent knee injury among athletes, and aged people with osteoporosis are at increased risk for it. For early detection and treatment, precise and rapid identification of ACL tears is significant. A fully automated system that can identify ACL tear is necessary to aid healthcare providers in determining the nature of injuries detected on Magnetic Resonance Imaging (MRI) scans. Two Convolutional Neural Networks (CNN), the pretrained model and the CustomNet model are trained and tested using 581 MRI scans of the knee. Feature extraction is done with the pre-trained ResNet-18 model, and the ISOMAP algorithm is used in the CustomNet model. Linear and nonlinear dimensionality reduction techniques are employed to extract the needed features from the image. For the ResNet-18 model, the accuracy rate ranges between 86% and 92% for various data partitions. After performing PCA, the improved classification rate ranges between 92% and 96.2%. The CustomNet model's accuracy rate ranges from 40 to 70%, 70-90%, 60-70%, and 50-70% for different hyperparameter ensembles. Five-fold cross validation is implemented in CustomNet and it achieved an overall accuracy of 85.6%. These two models demonstrate superior efficiency and accuracy in classifying normal and ACL torn Knee MR images.

Magnetic resonance imaging (MRI) quality assessment is crucial for clinical decision-making, yet remains challenging due to data scarcity and protocol variability. Traditional approaches face fundamental trade-offs: signal-based methods like MRIQC provide quantitative metrics but lack semantic understanding, while deep learning approaches achieve high accuracy but sacrifice interpretability. To address these limitations, we introduce the Multimodal MRI Quality Assessment (MMRQA) framework, pioneering the integration of multimodal large language models (MLLMs) with acquisition-aware signal processing. MMRQA combines three key innovations: robust metric extraction via MRQy augmented with simulated artifacts, structured transformation of metrics into question-answer pairs using Qwen, and parameter-efficient fusion through Low-Rank Adaptation (LoRA) of LLaVA-OneVision. Evaluated on MR-ART, FastMRI, and MyConnectome benchmarks, MMRQA achieves state-of-the-art performance with strong zero-shot generalization, as validated by comprehensive ablation studies. By bridging quantitative analysis with semantic reasoning, our framework generates clinically interpretable outputs that enhance quality control in dynamic medical settings.

Osteoporosis is an under-screened musculoskeletal disorder that results in diminished quality of life and significant burden to the healthcare system. We aimed to evaluate the ability of Rho, an artificial intelligence (AI) tool, to prospectively identify patients at-risk for low bone mineral density (BMD) from standard x-rays, its adoption rate by radiologists, and acceptance by primary care providers (PCPs). Patients ≥50 years were recruited when undergoing an x-ray of a Rho-eligible body part for any clinical indication. Questionnaires were completed at baseline and 6-month follow-up, and PCPs of "Rho-Positive" patients (those likely to have low BMD) were asked for feedback. Positive predictive value (PPV) was calculated in patients who returned within 6 months for a DXA. Of 1145 patients consented, 987 had x-rays screened by Rho, and 655 were flagged as Rho-Positive. Radiologists included this finding in 524 (80%) of reports. Of all Rho-Positive patients, 125 had a DXA within 6 months; Rho had a 74% PPV for DXA T-Score <-1. From 51 PCP responses, 78% found Rho beneficial. Of 389 patients with follow-up questionnaire data, a greater proportion of Rho-Positive versus -negative patients had discussed bone health with their PCP since study start (36% vs 18%, <i>P</i> < .001), or were newly diagnosed with osteoporosis (11% vs 5%; <i>P</i> = .03). By identifying patients at-risk of low BMD, with acceptability of reporting by radiologists and generally positive feedback from PCPs, Rho has the potential to improve low screening rates for osteoporosis by leveraging existing x-ray data.

Exploring the transition from acute to chronic temporomandibular disorders (TMD) remains challenging due to the multifactorial nature of the disease. This study aims to identify clinical, behavioral, and imaging-based predictors that contribute to symptom chronicity in patients with TMD. We enrolled 239 patients with TMD (161 women, 78 men; mean age 35.60 ± 17.93 years), classified as acute ( < 6 months) or chronic ( ≥ 6 months) based on symptom duration. TMD was diagnosed according to the Diagnostic Criteria for TMD (DC/TMD Axis I). Clinical data, sleep-related variables, and temporomandibular joint magnetic resonance imaging (MRI) were collected. MRI assessments included anterior disc displacement (ADD), joint space narrowing, osteoarthritis, and effusion using 3 T T2-weighted and proton density scans. Predictors were evaluated using logistic regression and deep neural networks (DNN), and performance was compared. Chronic TMD is observed in 51.05% of patients. Compared to acute cases, chronic TMD is more frequently associated with TMJ noise (70.5%), bruxism (31.1%), and higher pain intensity (VAS: 4.82 ± 2.47). They also have shorter sleep and higher STOP-Bang scores, indicating greater risk of obstructive sleep apnea. MRI findings reveal increased prevalence of ADD (86.9%), TMJ-OA (82.0%), and joint space narrowing (88.5%) in chronic TMD. Logistic regression achieves an AUROC of 0.7550 (95% CI: 0.6550-0.8550), identifying TMJ noise, bruxism, VAS, sleep disturbance, STOP-Bang≥5, ADD, and joint space narrowing as significant predictors. The DNN model improves accuracy to 79.49% compared to 75.50%, though the difference is not statistically significant (p = 0.3067). Behavioral and TMJ-related structural factors are key predictors of chronic TMD and may aid early identification. Timely recognition may support personalized strategies and improve outcomes.

Prostate cancer (PCa) is the most frequently diagnosed malignancy in men and the eighth leading cause of cancer death worldwide. Multiparametric MRI (mpMRI) has become central to the diagnostic pathway for men at intermediate risk, improving de-tection of clinically significant PCa (csPCa) while reducing unnecessary biopsies and over-diagnosis. However, mpMRI remains limited by false positives, false negatives, and moderate to substantial interobserver agreement. Time-dependent diffusion (TDD) MRI, a novel sequence that enables tissue microstructure characterization, has shown encouraging preclinical performance in distinguishing clinically significant from insignificant PCa. Combining TDD-derived metrics with machine learning may provide robust, zone-specific risk prediction with less dependence on reader training and improved accuracy compared to current standard-of-care. This study protocol out-lines the rationale and describes the prospective evaluation of a home-developed AI-enhanced TDD-MRI software (PROSTDAI) in routine diagnostic care, assessing its added value against PI-RADS v2.1 and validating results against MRI-guided prostate biopsy.

Brain strokes (BS) are potentially life-threatening cerebrovascular conditions and the second highest contributor to mortality. They include hemorrhagic and ischemic strokes, which vary greatly in size, shape, and location, posing significant challenges for automated identification. Magnetic Resonance Imaging (MRI) brain imaging using Diffusion Weighted Imaging (DWI) will show fluid balance changes very early. Due to their higher sensitivity, MRI scans are more accurate than Computed Tomography (CT) scans. Salp Shuffled Shepherded EfficientNet (S3ET-NET), a new deep learning model in this research work, could propose the detection of brain stroke using brain MRI. The MRI images are pre-processed by a Gaussian bilateral (GB) filter to reduce the noise distortion in the input images. The Ghost Net model derives suitable features from the pre-processed images. The extracted images will have some optimal features that were selected by applying the Salp Shuffled Shepherded Optimization (S3O) algorithm. The Efficient Net model is utilized for classifying brain stroke cases, such as normal, Ischemic stroke (IS), and hemorrhagic stroke (HS). According to the result, the proposed S3ET-NET attains a 99.41% reliability rate. In contrast to Link Net, Mobile Net, and Google Net, the proposed Ghost Net improves detection accuracy by 1.16, 1.94, and 3.14%, respectively. The suggested Efficient Net outperforms ResNet50, zNet-mRMR-NB, and DNN in the accuracy range, improving by 3.20, 5.22, and 4.21%, respectively.