GazeVaLM: A Multi-Observer Eye-Tracking Benchmark for Evaluating Clinical Realism in AI-Generated X-Rays

We introduce GazeVaLM, a public eye-tracking dataset for studying clinical perception during chest radiograph authenticity assessment. The dataset comprises 960 gaze recordings from 16 expert radiologists interpreting 30 real and 30 synthetic chest X-rays (generated by diffusion based generative AI) under two conditions: diagnostic assessment and real-fake classification (Visual Turing test). For each image-observer pair, we provide raw gaze samples, fixation maps, scanpaths, saliency density maps, structured diagnostic labels, and authenticity judgments. We extend the protocol to 6 state-of-the-art multimodal LLMs, releasing their predicted diagnoses, authenticity labels, and confidence scores under matched conditions - enabling direct human-AI comparison at both decision and uncertainty levels. We further provide analyses of gaze agreement, inter-observer consistency, and benchmarking of radiologists versus LLMs in diagnostic accuracy and authenticity detection. GazeVaLM supports research in gaze modeling, clinical decision-making, human-AI comparison, generative image realism assessment, and uncertainty quantification. By jointly releasing visual attention data, clinical labels, and model predictions, we aim to facilitate reproducible research on how experts and AI systems perceive, interpret, and evaluate medical images. The dataset is available at https://huggingface.co/datasets/davidcwong/GazeVaLM.

Progressive Deep Learning for Automated Spheno-Occipital Synchondrosis Maturation Assessment

Accurate assessment of spheno-occipital synchondrosis (SOS) maturation is a key indicator of craniofacial growth and a critical determinant for orthodontic and surgical timing. However, SOS staging from cone-beam CT (CBCT) relies on subtle, continuously evolving morphological cues, leading to high inter-observer variability and poor reproducibility, especially at transitional fusion stages. We frame SOS assessment as a fine-grained visual recognition problem and propose a progressive representation-learning framework that explicitly mirrors how expert clinicians reason about synchondral fusion: from coarse anatomical structure to increasingly subtle patterns of closure. Rather than training a full-capacity network end-to-end, we sequentially grow the model by activating deeper blocks over time, allowing early layers to first encode stable cranial base morphology before higher-level layers specialize in discriminating adjacent maturation stages. This yields a curriculum over network depth that aligns deep feature learning with the biological continuum of SOS fusion. Extensive experiments across convolutional and transformer-based architectures show that this expert-inspired training strategy produces more stable optimization and consistently higher accuracy than standard training, particularly for ambiguous intermediate stages. Importantly, these gains are achieved without changing network architectures or loss functions, demonstrating that training dynamics alone can substantially improve anatomical representation learning. The proposed framework establishes a principled link between expert dental intuition and deep visual representations, enabling robust, data-efficient SOS staging from CBCT and offering a general strategy for modeling other continuous biological processes in medical imaging.

What They Saw, Not Just Where They Looked: Semantic Scanpath Similarity via VLMs and NLP metric

Scanpath similarity metrics are central to eye-movement research, yet existing methods predominantly evaluate spatial and temporal alignment while neglecting semantic equivalence between attended image regions. We present a semantic scanpath similarity framework that integrates vision-language models (VLMs) into eye-tracking analysis. Each fixation is encoded under controlled visual context (patch-based and marker-based strategies) and transformed into concise textual descriptions, which are aggregated into scanpath-level representations. Semantic similarity is then computed using embedding-based and lexical NLP metrics and compared against established spatial measures, including MultiMatch and DTW. Experiments on free-viewing eye-tracking data demonstrate that semantic similarity captures partially independent variance from geometric alignment, revealing cases of high content agreement despite spatial divergence. We further analyze the impact of contextual encoding on description fidelity and metric stability. Our findings suggest that multimodal foundation models enable interpretable, content-aware extensions of classical scanpath analysis, providing a complementary dimension for gaze research within the ETRA community.

VP-Hype: A Hybrid Mamba-Transformer Framework with Visual-Textual Prompting for Hyperspectral Image Classification

Accurate classification of hyperspectral imagery (HSI) is often frustrated by the tension between high-dimensional spectral data and the extreme scarcity of labeled training samples. While hierarchical models like LoLA-SpecViT have demonstrated the power of local windowed attention and parameter-efficient fine-tuning, the quadratic complexity of standard Transformers remains a barrier to scaling. We introduce VP-Hype, a framework that rethinks HSI classification by unifying the linear-time efficiency of State-Space Models (SSMs) with the relational modeling of Transformers in a novel hybrid architecture. Building on a robust 3D-CNN spectral front-end, VP-Hype replaces conventional attention blocks with a Hybrid Mamba-Transformer backbone to capture long-range dependencies with significantly reduced computational overhead. Furthermore, we address the label-scarcity problem by integrating dual-modal Visual and Textual Prompts that provide context-aware guidance for the feature extraction process. Our experimental evaluation demonstrates that VP-Hype establishes a new state of the art in low-data regimes. Specifically, with a training sample distribution of only 2\%, the model achieves Overall Accuracy (OA) of 99.69\% on the Salinas dataset and 99.45\% on the Longkou dataset. These results suggest that the convergence of hybrid sequence modeling and multi-modal prompting provides a robust path forward for high-performance, sample-efficient remote sensing.

SPGen: Stochastic scanpath generation for paintings using unsupervised domain adaptation

Understanding human visual attention is key to preserving cultural heritage We introduce SPGen a novel deep learning model to predict scanpaths the sequence of eye movementswhen viewers observe paintings. Our architecture uses a Fully Convolutional Neural Network FCNN with differentiable fixation selection and learnable Gaussian priors to simulate natural viewing biases To address the domain gap between photographs and artworks we employ unsupervised domain adaptation via a gradient reversal layer allowing the model to transfer knowledge from natural scenes to paintings Furthermore a random noise sampler models the inherent stochasticity of eyetracking data. Extensive testing shows SPGen outperforms existing methods offering a powerful tool to analyze gaze behavior and advance the preservation and appreciation of artistic treasures.

Knowledge Distillation Approach for SOS Fusion Staging: Towards Fully Automated Skeletal Maturity Assessment

We introduce a novel deep learning framework for the automated staging of spheno-occipital synchondrosis (SOS) fusion, a critical diagnostic marker in both orthodontics and forensic anthropology. Our approach leverages a dual-model architecture wherein a teacher model, trained on manually cropped images, transfers its precise spatial understanding to a student model that operates on full, uncropped images. This knowledge distillation is facilitated by a newly formulated loss function that aligns spatial logits as well as incorporates gradient-based attention spatial mapping, ensuring that the student model internalizes the anatomically relevant features without relying on external cropping or YOLO-based segmentation. By leveraging expert-curated data and feedback at each step, our framework attains robust diagnostic accuracy, culminating in a clinically viable end-to-end pipeline. This streamlined approach obviates the need for additional pre-processing tools and accelerates deployment, thereby enhancing both the efficiency and consistency of skeletal maturation assessment in diverse clinical settings.

Modeling Beyond MOS: Quality Assessment Models Must Integrate Context, Reasoning, and Multimodality

This position paper argues that Mean Opinion Score (MOS), while historically foundational, is no longer sufficient as the sole supervisory signal for multimedia quality assessment models. MOS reduces rich, context-sensitive human judgments to a single scalar, obscuring semantic failures, user intent, and the rationale behind quality decisions. We contend that modern quality assessment models must integrate three interdependent capabilities: (1) context-awareness, to adapt evaluations to task-specific goals and viewing conditions; (2) reasoning, to produce interpretable, evidence-grounded justifications for quality judgments; and (3) multimodality, to align perceptual and semantic cues using vision-language models. We critique the limitations of current MOS-centric benchmarks and propose a roadmap for reform: richer datasets with contextual metadata and expert rationales, and new evaluation metrics that assess semantic alignment, reasoning fidelity, and contextual sensitivity. By reframing quality assessment as a contextual, explainable, and multimodal modeling task, we aim to catalyze a shift toward more robust, human-aligned, and trustworthy evaluation systems.

Gradient Attention Map Based Verification of Deep Convolutional Neural Networks with Application to X-ray Image Datasets

Deep learning models have great potential in medical imaging, including orthodontics and skeletal maturity assessment. However, applying a model to data different from its training set can lead to unreliable predictions that may impact patient care. To address this, we propose a comprehensive verification framework that evaluates model suitability through multiple complementary strategies. First, we introduce a Gradient Attention Map (GAM)-based approach that analyzes attention patterns using Grad-CAM and compares them via similarity metrics such as IoU, Dice Similarity, SSIM, Cosine Similarity, Pearson Correlation, KL Divergence, and Wasserstein Distance. Second, we extend verification to early convolutional feature maps, capturing structural mis-alignments missed by attention alone. Finally, we incorporate an additional garbage class into the classification model to explicitly reject out-of-distribution inputs. Experimental results demonstrate that these combined methods effectively identify unsuitable models and inputs, promoting safer and more reliable deployment of deep learning in medical imaging.

Shifts in Doctors' Eye Movements Between Real and AI-Generated Medical Images

Eye-tracking analysis plays a vital role in medical imaging, providing key insights into how radiologists visually interpret and diagnose clinical cases. In this work, we first analyze radiologists' attention and agreement by measuring the distribution of various eye-movement patterns, including saccades direction, amplitude, and their joint distribution. These metrics help uncover patterns in attention allocation and diagnostic strategies. Furthermore, we investigate whether and how doctors' gaze behavior shifts when viewing authentic (Real) versus deep-learning-generated (Fake) images. To achieve this, we examine fixation bias maps, focusing on first, last, short, and longest fixations independently, along with detailed saccades patterns, to quantify differences in gaze distribution and visual saliency between authentic and synthetic images.

Eyes Tell the Truth: GazeVal Highlights Shortcomings of Generative AI in Medical Imaging

The demand for high-quality synthetic data for model training and augmentation has never been greater in medical imaging. However, current evaluations predominantly rely on computational metrics that fail to align with human expert recognition. This leads to synthetic images that may appear realistic numerically but lack clinical authenticity, posing significant challenges in ensuring the reliability and effectiveness of AI-driven medical tools. To address this gap, we introduce GazeVal, a practical framework that synergizes expert eye-tracking data with direct radiological evaluations to assess the quality of synthetic medical images. GazeVal leverages gaze patterns of radiologists as they provide a deeper understanding of how experts perceive and interact with synthetic data in different tasks (i.e., diagnostic or Turing tests). Experiments with sixteen radiologists revealed that 96.6% of the generated images (by the most recent state-of-the-art AI algorithm) were identified as fake, demonstrating the limitations of generative AI in producing clinically accurate images.