Closed-loop coupling of personalised and foundation models for real-time treatment guidance with MRI

Image-guided therapies, including radiotherapy, biopsy and deep brain stimulation, rely on real-time targeting of anatomical structures. However, in the presence of motion, imaging latencies create a temporal misalignment between observed and true anatomy, compromising treatment accuracy. Artificial intelligence-based frameworks have increasingly been presented to close this latency gap, but leading personalised models can fail due to a lack of stable anatomical grounding. Foundation models can provide grounded behaviour, but they do not adapt to real-time, individual patient dynamics. Here we introduce a closed-loop coupling framework that synergises patient-specific temporal prediction with continuous segmentation-based anatomical interpretation from a foundation model. A personalised model predicts future anatomy to compensate for system latency, while a streaming foundation model provides anatomical supervision used to continuously update the temporal predictor in real time during treatment. We validate the framework using a digital phantom and intrafraction magnetic resonance imaging (MRI) from patients undergoing MRI-guided radiotherapy. For a prediction horizon of 400 ms, the proposed method improves anatomical prediction and reduces dosimetric error compared with existing approaches, within clinically relevant latency constraints. These results establish closed-loop coupling as a general strategy for real-time image-guided intervention.

Enhancing Ultra-low-field MRI with Segmentation-guided Adversarial Learning

Ultra-low-field (ULF) MRI offers portable and low-cost imaging but suffers from poor image quality. To address this, we present our submission to the 2025 ULF Enhancement Challenge (ULF-EnC), where the goal is to synthesise high-field-like MRIs from 64 mT scans. Our pipeline enhances ULF MRI through a combination of anatomical conditioning and model ensembling. We first generate tissue segmentation priors using a Swin UNETR trained solely on challenge-provided data. These priors condition two independent enhancement networks - a CycleGAN and a transformer-based residual enhancement model (T-REX) - each trained to synthesise 3 T-like MRIs. Outputs from both models are combined using a weighted average. Our approach produces enhanced MRIs that were comparable to high-field scans both quantitatively and qualitatively.