APTOS-2024 challenge report: Generation of synthetic 3D OCT images from fundus photographs

Optical Coherence Tomography (OCT) provides high-resolution, 3D, and non-invasive visualization of retinal layers in vivo, serving as a critical tool for lesion localization and disease diagnosis. However, its widespread adoption is limited by equipment costs and the need for specialized operators. In comparison, 2D color fundus photography offers faster acquisition and greater accessibility with less dependence on expensive devices. Although generative artificial intelligence has demonstrated promising results in medical image synthesis, translating 2D fundus images into 3D OCT images presents unique challenges due to inherent differences in data dimensionality and biological information between modalities. To advance generative models in the fundus-to-3D-OCT setting, the Asia Pacific Tele-Ophthalmology Society (APTOS-2024) organized a challenge titled Artificial Intelligence-based OCT Generation from Fundus Images. This paper details the challenge framework (referred to as APTOS-2024 Challenge), including: the benchmark dataset, evaluation methodology featuring two fidelity metrics-image-based distance (pixel-level OCT B-scan similarity) and video-based distance (semantic-level volumetric consistency), and analysis of top-performing solutions. The challenge attracted 342 participating teams, with 42 preliminary submissions and 9 finalists. Leading methodologies incorporated innovations in hybrid data preprocessing or augmentation (cross-modality collaborative paradigms), pre-training on external ophthalmic imaging datasets, integration of vision foundation models, and model architecture improvement. The APTOS-2024 Challenge is the first benchmark demonstrating the feasibility of fundus-to-3D-OCT synthesis as a potential solution for improving ophthalmic care accessibility in under-resourced healthcare settings, while helping to expedite medical research and clinical applications.

PathFL: Multi-Alignment Federated Learning for Pathology Image Segmentation

Pathology image segmentation across multiple centers encounters significant challenges due to diverse sources of heterogeneity including imaging modalities, organs, and scanning equipment, whose variability brings representation bias and impedes the development of generalizable segmentation models. In this paper, we propose PathFL, a novel multi-alignment Federated Learning framework for pathology image segmentation that addresses these challenges through three-level alignment strategies of image, feature, and model aggregation. Firstly, at the image level, a collaborative style enhancement module aligns and diversifies local data by facilitating style information exchange across clients. Secondly, at the feature level, an adaptive feature alignment module ensures implicit alignment in the representation space by infusing local features with global insights, promoting consistency across heterogeneous client features learning. Finally, at the model aggregation level, a stratified similarity aggregation strategy hierarchically aligns and aggregates models on the server, using layer-specific similarity to account for client discrepancies and enhance global generalization. Comprehensive evaluations on four sets of heterogeneous pathology image datasets, encompassing cross-source, cross-modality, cross-organ, and cross-scanner variations, validate the effectiveness of our PathFL in achieving better performance and robustness against data heterogeneity.

Few-Shot Learning from Gigapixel Images via Hierarchical Vision-Language Alignment and Modeling

Vision-language models (VLMs) have recently been integrated into multiple instance learning (MIL) frameworks to address the challenge of few-shot, weakly supervised classification of whole slide images (WSIs). A key trend involves leveraging multi-scale information to better represent hierarchical tissue structures. However, existing methods often face two key limitations: (1) insufficient modeling of interactions within the same modalities across scales (e.g., 5x and 20x) and (2) inadequate alignment between visual and textual modalities on the same scale. To address these gaps, we propose HiVE-MIL, a hierarchical vision-language framework that constructs a unified graph consisting of (1) parent-child links between coarse (5x) and fine (20x) visual/textual nodes to capture hierarchical relationships, and (2) heterogeneous intra-scale edges linking visual and textual nodes on the same scale. To further enhance semantic consistency, HiVE-MIL incorporates a two-stage, text-guided dynamic filtering mechanism that removes weakly correlated patch-text pairs, and introduces a hierarchical contrastive loss to align textual semantics across scales. Extensive experiments on TCGA breast, lung, and kidney cancer datasets demonstrate that HiVE-MIL consistently outperforms both traditional MIL and recent VLM-based MIL approaches, achieving gains of up to 4.1% in macro F1 under 16-shot settings. Our results demonstrate the value of jointly modeling hierarchical structure and multimodal alignment for efficient and scalable learning from limited pathology data. The code is available at https://github.com/bryanwong17/HiVE-MIL

Generative Models in Computational Pathology: A Comprehensive Survey on Methods, Applications, and Challenges

Generative modeling has emerged as a promising direction in computational pathology, offering capabilities such as data-efficient learning, synthetic data augmentation, and multimodal representation across diverse diagnostic tasks. This review provides a comprehensive synthesis of recent progress in the field, organized into four key domains: image generation, text generation, multimodal image-text generation, and other generative applications, including spatial simulation and molecular inference. By analyzing over 150 representative studies, we trace the evolution of generative architectures from early generative adversarial networks to recent advances in diffusion models and foundation models with generative capabilities. We further examine the datasets and evaluation protocols commonly used in this domain and highlight ongoing limitations, including challenges in generating high-fidelity whole slide images, clinical interpretability, and concerns related to the ethical and legal implications of synthetic data. The review concludes with a discussion of open challenges and prospective research directions, with an emphasis on developing unified, multimodal, and clinically deployable generative systems. This work aims to provide a foundational reference for researchers and practitioners developing and applying generative models in computational pathology.

Prompt Guiding Multi-Scale Adaptive Sparse Representation-driven Network for Low-Dose CT MAR

Low-dose CT (LDCT) is capable of reducing X-ray radiation exposure, but it will potentially degrade image quality, even yields metal artifacts at the case of metallic implants. For simultaneous LDCT reconstruction and metal artifact reduction (LDMAR), existing deep learning-based efforts face two main limitations: i) the network design neglects multi-scale and within-scale information; ii) training a distinct model for each dose necessitates significant storage space for multiple doses. To fill these gaps, we propose a prompt guiding multi-scale adaptive sparse representation-driven network, abbreviated as PMSRNet, for LDMAR task. Specifically, we construct PMSRNet inspired from multi-scale sparsifying frames, and it can simultaneously employ within-scale characteristics and cross-scale complementarity owing to an elaborated prompt guiding scale-adaptive threshold generator (PSATG) and a built multi-scale coefficient fusion module (MSFuM). The PSATG can adaptively capture multiple contextual information to generate more faithful thresholds, achieved by fusing features from local, regional, and global levels. Furthermore, we elaborate a model interpretable dual domain LDMAR framework called PDuMSRNet, and train single model with a prompt guiding strategy for multiple dose levels. We build a prompt guiding module, whose input contains dose level, metal mask and input instance, to provide various guiding information, allowing a single model to accommodate various CT dose settings. Extensive experiments at various dose levels demonstrate that the proposed methods outperform the state-of-the-art LDMAR methods.

A Clinician-Friendly Platform for Ophthalmic Image Analysis Without Technical Barriers

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, but current models typically require retraining when deployed across different clinical centers, limiting their widespread adoption. We introduce GlobeReady, a clinician-friendly AI platform that enables ocular disease diagnosis without retraining/fine-tuning or technical expertise. GlobeReady achieves high accuracy across imaging modalities: 93.9-98.5% for an 11-category fundus photo dataset and 87.2-92.7% for a 15-category OCT dataset. Through training-free local feature augmentation, it addresses domain shifts across centers and populations, reaching an average accuracy of 88.9% across five centers in China, 86.3% in Vietnam, and 90.2% in the UK. The built-in confidence-quantifiable diagnostic approach further boosted accuracy to 94.9-99.4% (fundus) and 88.2-96.2% (OCT), while identifying out-of-distribution cases at 86.3% (49 CFP categories) and 90.6% (13 OCT categories). Clinicians from multiple countries rated GlobeReady highly (average 4.6 out of 5) for its usability and clinical relevance. These results demonstrate GlobeReady's robust, scalable diagnostic capability and potential to support ophthalmic care without technical barriers.

Vision-Amplified Semantic Entropy for Hallucination Detection in Medical Visual Question Answering

Multimodal large language models (MLLMs) have demonstrated significant potential in medical Visual Question Answering (VQA). Yet, they remain prone to hallucinations-incorrect responses that contradict input images, posing substantial risks in clinical decision-making. Detecting these hallucinations is essential for establishing trust in MLLMs among clinicians and patients, thereby enabling their real-world adoption. Current hallucination detection methods, especially semantic entropy (SE), have demonstrated promising hallucination detection capacity for LLMs. However, adapting SE to medical MLLMs by incorporating visual perturbations presents a dilemma. Weak perturbations preserve image content and ensure clinical validity, but may be overlooked by medical MLLMs, which tend to over rely on language priors. In contrast, strong perturbations can distort essential diagnostic features, compromising clinical interpretation. To address this issue, we propose Vision Amplified Semantic Entropy (VASE), which incorporates weak image transformations and amplifies the impact of visual input, to improve hallucination detection in medical VQA. We first estimate the semantic predictive distribution under weak visual transformations to preserve clinical validity, and then amplify visual influence by contrasting this distribution with that derived from a distorted image. The entropy of the resulting distribution is estimated as VASE. Experiments on two medical open-ended VQA datasets demonstrate that VASE consistently outperforms existing hallucination detection methods.

Dynamic Allocation Hypernetwork with Adaptive Model Recalibration for Federated Continual Learning

Federated continual learning (FCL) offers an emerging pattern to facilitate the applicability of federated learning (FL) in real-world scenarios, where tasks evolve dynamically and asynchronously across clients, especially in medical scenario. Existing server-side FCL methods in nature domain construct a continually learnable server model by client aggregation on all-involved tasks. However, they are challenged by: (1) Catastrophic forgetting for previously learned tasks, leading to error accumulation in server model, making it difficult to sustain comprehensive knowledge across all tasks. (2) Biased optimization due to asynchronous tasks handled across different clients, leading to the collision of optimization targets of different clients at the same time steps. In this work, we take the first step to propose a novel server-side FCL pattern in medical domain, Dynamic Allocation Hypernetwork with adaptive model recalibration (FedDAH). It is to facilitate collaborative learning under the distinct and dynamic task streams across clients. To alleviate the catastrophic forgetting, we propose a dynamic allocation hypernetwork (DAHyper) where a continually updated hypernetwork is designed to manage the mapping between task identities and their associated model parameters, enabling the dynamic allocation of the model across clients. For the biased optimization, we introduce a novel adaptive model recalibration (AMR) to incorporate the candidate changes of historical models into current server updates, and assign weights to identical tasks across different time steps based on the similarity for continual optimization. Extensive experiments on the AMOS dataset demonstrate the superiority of our FedDAH to other FCL methods on sites with different task streams. The code is available:https://github.com/jinlab-imvr/FedDAH.

MExD: An Expert-Infused Diffusion Model for Whole-Slide Image Classification

Whole Slide Image (WSI) classification poses unique challenges due to the vast image size and numerous non-informative regions, which introduce noise and cause data imbalance during feature aggregation. To address these issues, we propose MExD, an Expert-Infused Diffusion Model that combines the strengths of a Mixture-of-Experts (MoE) mechanism with a diffusion model for enhanced classification. MExD balances patch feature distribution through a novel MoE-based aggregator that selectively emphasizes relevant information, effectively filtering noise, addressing data imbalance, and extracting essential features. These features are then integrated via a diffusion-based generative process to directly yield the class distribution for the WSI. Moving beyond conventional discriminative approaches, MExD represents the first generative strategy in WSI classification, capturing fine-grained details for robust and precise results. Our MExD is validated on three widely-used benchmarks-Camelyon16, TCGA-NSCLC, and BRACS consistently achieving state-of-the-art performance in both binary and multi-class tasks.

Partially Supervised Unpaired Multi-Modal Learning for Label-Efficient Medical Image Segmentation

Unpaired Multi-Modal Learning (UMML) which leverages unpaired multi-modal data to boost model performance on each individual modality has attracted a lot of research interests in medical image analysis. However, existing UMML methods require multi-modal datasets to be fully labeled, which incurs tremendous annotation cost. In this paper, we investigate the use of partially labeled data for label-efficient unpaired multi-modal learning, which can reduce the annotation cost by up to one half. We term the new learning paradigm as Partially Supervised Unpaired Multi-Modal Learning (PSUMML) and propose a novel Decomposed partial class adaptation with snapshot Ensembled Self-Training (DEST) framework for it. Specifically, our framework consists of a compact segmentation network with modality specific normalization layers for learning with partially labeled unpaired multi-modal data. The key challenge in PSUMML lies in the complex partial class distribution discrepancy due to partial class annotation, which hinders effective knowledge transfer across modalities. We theoretically analyze this phenomenon with a decomposition theorem and propose a decomposed partial class adaptation technique to precisely align the partially labeled classes across modalities to reduce the distribution discrepancy. We further propose a snapshot ensembled self-training technique to leverage the valuable snapshot models during training to assign pseudo-labels to partially labeled pixels for self-training to boost model performance. We perform extensive experiments under different scenarios of PSUMML for two medical image segmentation tasks, namely cardiac substructure segmentation and abdominal multi-organ segmentation. Our framework outperforms existing methods significantly.