A computationally frugal open-source foundation model for thoracic disease detection in lung cancer screening programs

Low-dose computed tomography (LDCT) imaging employed in lung cancer screening (LCS) programs is increasing in uptake worldwide. LCS programs herald a generational opportunity to simultaneously detect cancer and non-cancer-related early-stage lung disease. Yet these efforts are hampered by a shortage of radiologists to interpret scans at scale. Here, we present TANGERINE, a computationally frugal, open-source vision foundation model for volumetric LDCT analysis. Designed for broad accessibility and rapid adaptation, TANGERINE can be fine-tuned off the shelf for a wide range of disease-specific tasks with limited computational resources and training data. Relative to models trained from scratch, TANGERINE demonstrates fast convergence during fine-tuning, thereby requiring significantly fewer GPU hours, and displays strong label efficiency, achieving comparable or superior performance with a fraction of fine-tuning data. Pretrained using self-supervised learning on over 98,000 thoracic LDCTs, including the UK's largest LCS initiative to date and 27 public datasets, TANGERINE achieves state-of-the-art performance across 14 disease classification tasks, including lung cancer and multiple respiratory diseases, while generalising robustly across diverse clinical centres. By extending a masked autoencoder framework to 3D imaging, TANGERINE offers a scalable solution for LDCT analysis, departing from recent closed, resource-intensive models by combining architectural simplicity, public availability, and modest computational requirements. Its accessible, open-source lightweight design lays the foundation for rapid integration into next-generation medical imaging tools that could transform LCS initiatives, allowing them to pivot from a singular focus on lung cancer detection to comprehensive respiratory disease management in high-risk populations.

Tackling Hallucination from Conditional Models for Medical Image Reconstruction with DynamicDPS

Hallucinations are spurious structures not present in the ground truth, posing a critical challenge in medical image reconstruction, especially for data-driven conditional models. We hypothesize that combining an unconditional diffusion model with data consistency, trained on a diverse dataset, can reduce these hallucinations. Based on this, we propose DynamicDPS, a diffusion-based framework that integrates conditional and unconditional diffusion models to enhance low-quality medical images while systematically reducing hallucinations. Our approach first generates an initial reconstruction using a conditional model, then refines it with an adaptive diffusion-based inverse problem solver. DynamicDPS skips early stage in the reverse process by selecting an optimal starting time point per sample and applies Wolfe's line search for adaptive step sizes, improving both efficiency and image fidelity. Using diffusion priors and data consistency, our method effectively reduces hallucinations from any conditional model output. We validate its effectiveness in Image Quality Transfer for low-field MRI enhancement. Extensive evaluations on synthetic and real MR scans, including a downstream task for tissue volume estimation, show that DynamicDPS reduces hallucinations, improving relative volume estimation by over 15% for critical tissues while using only 5% of the sampling steps required by baseline diffusion models. As a model-agnostic and fine-tuning-free approach, DynamicDPS offers a robust solution for hallucination reduction in medical imaging. The code will be made publicly available upon publication.

Brain Latent Progression: Individual-based Spatiotemporal Disease Progression on 3D Brain MRIs via Latent Diffusion

The growing availability of longitudinal Magnetic Resonance Imaging (MRI) datasets has facilitated Artificial Intelligence (AI)-driven modeling of disease progression, making it possible to predict future medical scans for individual patients. However, despite significant advancements in AI, current methods continue to face challenges including achieving patient-specific individualization, ensuring spatiotemporal consistency, efficiently utilizing longitudinal data, and managing the substantial memory demands of 3D scans. To address these challenges, we propose Brain Latent Progression (BrLP), a novel spatiotemporal model designed to predict individual-level disease progression in 3D brain MRIs. The key contributions in BrLP are fourfold: (i) it operates in a small latent space, mitigating the computational challenges posed by high-dimensional imaging data; (ii) it explicitly integrates subject metadata to enhance the individualization of predictions; (iii) it incorporates prior knowledge of disease dynamics through an auxiliary model, facilitating the integration of longitudinal data; and (iv) it introduces the Latent Average Stabilization (LAS) algorithm, which (a) enforces spatiotemporal consistency in the predicted progression at inference time and (b) allows us to derive a measure of the uncertainty for the prediction. We train and evaluate BrLP on 11,730 T1-weighted (T1w) brain MRIs from 2,805 subjects and validate its generalizability on an external test set comprising 2,257 MRIs from 962 subjects. Our experiments compare BrLP-generated MRI scans with real follow-up MRIs, demonstrating state-of-the-art accuracy compared to existing methods. The code is publicly available at: https://github.com/LemuelPuglisi/BrLP.

4D VQ-GAN: Synthesising Medical Scans at Any Time Point for Personalised Disease Progression Modelling of Idiopathic Pulmonary Fibrosis

Understanding the progression trajectories of diseases is crucial for early diagnosis and effective treatment planning. This is especially vital for life-threatening conditions such as Idiopathic Pulmonary Fibrosis (IPF), a chronic, progressive lung disease with a prognosis comparable to many cancers. Computed tomography (CT) imaging has been established as a reliable diagnostic tool for IPF. Accurately predicting future CT scans of early-stage IPF patients can aid in developing better treatment strategies, thereby improving survival outcomes. In this paper, we propose 4D Vector Quantised Generative Adversarial Networks (4D-VQ-GAN), a model capable of generating realistic CT volumes of IPF patients at any time point. The model is trained using a two-stage approach. In the first stage, a 3D-VQ-GAN is trained to reconstruct CT volumes. In the second stage, a Neural Ordinary Differential Equation (ODE) based temporal model is trained to capture the temporal dynamics of the quantised embeddings generated by the encoder in the first stage. We evaluate different configurations of our model for generating longitudinal CT scans and compare the results against ground truth data, both quantitatively and qualitatively. For validation, we conduct survival analysis using imaging biomarkers derived from generated CT scans and achieve a C-index comparable to that of biomarkers derived from the real CT scans. The survival analysis results demonstrate the potential clinical utility inherent to generated longitudinal CT scans, showing that they can reliably predict survival outcomes.

MRI Parameter Mapping via Gaussian Mixture VAE: Breaking the Assumption of Independent Pixels

We introduce and demonstrate a new paradigm for quantitative parameter mapping in MRI. Parameter mapping techniques, such as diffusion MRI and quantitative MRI, have the potential to robustly and repeatably measure biologically-relevant tissue maps that strongly relate to underlying microstructure. Quantitative maps are calculated by fitting a model to multiple images, e.g. with least-squares or machine learning. However, the overwhelming majority of model fitting techniques assume that each voxel is independent, ignoring any co-dependencies in the data. This makes model fitting sensitive to voxelwise measurement noise, hampering reliability and repeatability. We propose a self-supervised deep variational approach that breaks the assumption of independent pixels, leveraging redundancies in the data to effectively perform data-driven regularisation of quantitative maps. We demonstrate that our approach outperforms current model fitting techniques in dMRI simulations and real data. Especially with a Gaussian mixture prior, our model enables sharper quantitative maps, revealing finer anatomical details that are not presented in the baselines. Our approach can hence support the clinical adoption of parameter mapping methods such as dMRI and qMRI.

Alternative Learning Paradigms for Image Quality Transfer

Image Quality Transfer (IQT) aims to enhance the contrast and resolution of low-quality medical images, e.g. obtained from low-power devices, with rich information learned from higher quality images. In contrast to existing IQT methods which adopt supervised learning frameworks, in this work, we propose two novel formulations of the IQT problem. The first approach uses an unsupervised learning framework, whereas the second is a combination of both supervised and unsupervised learning. The unsupervised learning approach considers a sparse representation (SRep) and dictionary learning model, which we call IQT-SRep, whereas the combination of supervised and unsupervised learning approach is based on deep dictionary learning (DDL), which we call IQT-DDL. The IQT-SRep approach trains two dictionaries using a SRep model using pairs of low- and high-quality volumes. Subsequently, the SRep of a low-quality block, in terms of the low-quality dictionary, can be directly used to recover the corresponding high-quality block using the high-quality dictionary. On the other hand, the IQT-DDL approach explicitly learns a high-resolution dictionary to upscale the input volume, while the entire network, including high dictionary generator, is simultaneously optimised to take full advantage of deep learning methods. The two models are evaluated using a low-field magnetic resonance imaging (MRI) application aiming to recover high-quality images akin to those obtained from high-field scanners. Experiments comparing the proposed approaches against state-of-the-art supervised deep learning IQT method (IQT-DL) identify that the two novel formulations of the IQT problem can avoid bias associated with supervised methods when tested using out-of-distribution data that differs from the distribution of the data the model was trained on. This highlights the potential benefit of these novel paradigms for IQT.

Unscrambling disease progression at scale: fast inference of event permutations with optimal transport

Disease progression models infer group-level temporal trajectories of change in patients' features as a chronic degenerative condition plays out. They provide unique insight into disease biology and staging systems with individual-level clinical utility. Discrete models consider disease progression as a latent permutation of events, where each event corresponds to a feature becoming measurably abnormal. However, permutation inference using traditional maximum likelihood approaches becomes prohibitive due to combinatoric explosion, severely limiting model dimensionality and utility. Here we leverage ideas from optimal transport to model disease progression as a latent permutation matrix of events belonging to the Birkhoff polytope, facilitating fast inference via optimisation of the variational lower bound. This enables a factor of 1000 times faster inference than the current state of the art and, correspondingly, supports models with several orders of magnitude more features than the current state of the art can consider. Experiments demonstrate the increase in speed, accuracy and robustness to noise in simulation. Further experiments with real-world imaging data from two separate datasets, one from Alzheimer's disease patients, the other age-related macular degeneration, showcase, for the first time, pixel-level disease progression events in the brain and eye, respectively. Our method is low compute, interpretable and applicable to any progressive condition and data modality, giving it broad potential clinical utility.

An X-Ray Is Worth 15 Features: Sparse Autoencoders for Interpretable Radiology Report Generation

Radiological services are experiencing unprecedented demand, leading to increased interest in automating radiology report generation. Existing Vision-Language Models (VLMs) suffer from hallucinations, lack interpretability, and require expensive fine-tuning. We introduce SAE-Rad, which uses sparse autoencoders (SAEs) to decompose latent representations from a pre-trained vision transformer into human-interpretable features. Our hybrid architecture combines state-of-the-art SAE advancements, achieving accurate latent reconstructions while maintaining sparsity. Using an off-the-shelf language model, we distil ground-truth reports into radiological descriptions for each SAE feature, which we then compile into a full report for each image, eliminating the need for fine-tuning large models for this task. To the best of our knowledge, SAE-Rad represents the first instance of using mechanistic interpretability techniques explicitly for a downstream multi-modal reasoning task. On the MIMIC-CXR dataset, SAE-Rad achieves competitive radiology-specific metrics compared to state-of-the-art models while using significantly fewer computational resources for training. Qualitative analysis reveals that SAE-Rad learns meaningful visual concepts and generates reports aligning closely with expert interpretations. Our results suggest that SAEs can enhance multimodal reasoning in healthcare, providing a more interpretable alternative to existing VLMs.

DARES: Depth Anything in Robotic Endoscopic Surgery with Self-supervised Vector-LoRA of the Foundation Model

Robotic-assisted surgery (RAS) relies on accurate depth estimation for 3D reconstruction and visualization. While foundation models like Depth Anything Models (DAM) show promise, directly applying them to surgery often yields suboptimal results. Fully fine-tuning on limited surgical data can cause overfitting and catastrophic forgetting, compromising model robustness and generalization. Although Low-Rank Adaptation (LoRA) addresses some adaptation issues, its uniform parameter distribution neglects the inherent feature hierarchy, where earlier layers, learning more general features, require more parameters than later ones. To tackle this issue, we introduce Depth Anything in Robotic Endoscopic Surgery (DARES), a novel approach that employs a new adaptation technique, Vector Low-Rank Adaptation (Vector-LoRA) on the DAM V2 to perform self-supervised monocular depth estimation in RAS scenes. To enhance learning efficiency, we introduce Vector-LoRA by integrating more parameters in earlier layers and gradually decreasing parameters in later layers. We also design a reprojection loss based on the multi-scale SSIM error to enhance depth perception by better tailoring the foundation model to the specific requirements of the surgical environment. The proposed method is validated on the SCARED dataset and demonstrates superior performance over recent state-of-the-art self-supervised monocular depth estimation techniques, achieving an improvement of 13.3% in the absolute relative error metric. The code and pre-trained weights are available at https://github.com/mobarakol/DARES.

Image Quality Transfer of Diffusion MRI Guided By High-Resolution Structural MRI

Prior work on the Image Quality Transfer on Diffusion MRI (dMRI) has shown significant improvement over traditional interpolation methods. However, the difficulty in obtaining ultra-high resolution Diffusion MRI scans poses a problem in training neural networks to obtain high-resolution dMRI scans. Here we hypothesise that the inclusion of structural MRI images, which can be acquired at much higher resolutions, can be used as a guide to obtaining a more accurate high-resolution dMRI output. To test our hypothesis, we have constructed a novel framework that incorporates structural MRI scans together with dMRI to obtain high-resolution dMRI scans. We set up tests which evaluate the validity of our claim through various configurations and compare the performance of our approach against a unimodal approach. Our results show that the inclusion of structural MRI scans do lead to an improvement in high-resolution image prediction when T1w data is incorporated into the model input.