ProtoFlow: Interpretable and Robust Surgical Workflow Modeling with Learned Dynamic Scene Graph Prototypes

Purpose: Detailed surgical recognition is critical for advancing AI-assisted surgery, yet progress is hampered by high annotation costs, data scarcity, and a lack of interpretable models. While scene graphs offer a structured abstraction of surgical events, their full potential remains untapped. In this work, we introduce ProtoFlow, a novel framework that learns dynamic scene graph prototypes to model complex surgical workflows in an interpretable and robust manner. Methods: ProtoFlow leverages a graph neural network (GNN) encoder-decoder architecture that combines self-supervised pretraining for rich representation learning with a prototype-based fine-tuning stage. This process discovers and refines core prototypes that encapsulate recurring, clinically meaningful patterns of surgical interaction, forming an explainable foundation for workflow analysis. Results: We evaluate our approach on the fine-grained CAT-SG dataset. ProtoFlow not only outperforms standard GNN baselines in overall accuracy but also demonstrates exceptional robustness in limited-data, few-shot scenarios, maintaining strong performance when trained on as few as one surgical video. Our qualitative analyses further show that the learned prototypes successfully identify distinct surgical sub-techniques and provide clear, interpretable insights into workflow deviations and rare complications. Conclusion: By uniting robust representation learning with inherent explainability, ProtoFlow represents a significant step toward developing more transparent, reliable, and data-efficient AI systems, accelerating their potential for clinical adoption in surgical training, real-time decision support, and workflow optimization.

UnReflectAnything: RGB-Only Highlight Removal by Rendering Synthetic Specular Supervision

Specular highlights distort appearance, obscure texture, and hinder geometric reasoning in both natural and surgical imagery. We present UnReflectAnything, an RGB-only framework that removes highlights from a single image by predicting a highlight map together with a reflection-free diffuse reconstruction. The model uses a frozen vision transformer encoder to extract multi-scale features, a lightweight head to localize specular regions, and a token-level inpainting module that restores corrupted feature patches before producing the final diffuse image. To overcome the lack of paired supervision, we introduce a Virtual Highlight Synthesis pipeline that renders physically plausible specularities using monocular geometry, Fresnel-aware shading, and randomized lighting which enables training on arbitrary RGB images with correct geometric structure. UnReflectAnything generalizes across natural and surgical domains where non-Lambertian surfaces and non-uniform lighting create severe highlights and it achieves competitive performance with state-of-the-art results on several benchmarks. Project Page: https://alberto-rota.github.io/UnReflectAnything/

LapFM: A Laparoscopic Segmentation Foundation Model via Hierarchical Concept Evolving Pre-training

Surgical segmentation is pivotal for scene understanding yet remains hindered by annotation scarcity and semantic inconsistency across diverse procedures. Existing approaches typically fine-tune natural foundation models (e.g., SAM) with limited supervision, functioning merely as domain adapters rather than surgical foundation models. Consequently, they struggle to generalize across the vast variability of surgical targets. To bridge this gap, we present LapFM, a foundation model designed to evolve robust segmentation capabilities from massive unlabeled surgical images. Distinct from medical foundation models relying on inefficient self-supervised proxy tasks, LapFM leverages a Hierarchical Concept Evolving Pre-training paradigm. First, we establish a Laparoscopic Concept Hierarchy (LCH) via a hierarchical mask decoder with parent-child query embeddings, unifying diverse entities (i.e., Anatomy, Tissue, and Instrument) into a scalable knowledge structure with cross-granularity semantic consistency. Second, we propose a Confidence-driven Evolving Labeling that iteratively generates and filters pseudo-labels based on hierarchical consistency, progressively incorporating reliable samples from unlabeled images into training. This process yields LapBench-114K, a large-scale benchmark comprising 114K image-mask pairs. Extensive experiments demonstrate that LapFM significantly outperforms state-of-the-art methods, establishing new standards for granularity-adaptive generalization in universal laparoscopic segmentation. The source code is available at https://github.com/xq141839/LapFM.

US-X Complete: A Multi-Modal Approach to Anatomical 3D Shape Recovery

Ultrasound offers a radiation-free, cost-effective solution for real-time visualization of spinal landmarks, paraspinal soft tissues and neurovascular structures, making it valuable for intraoperative guidance during spinal procedures. However, ultrasound suffers from inherent limitations in visualizing complete vertebral anatomy, in particular vertebral bodies, due to acoustic shadowing effects caused by bone. In this work, we present a novel multi-modal deep learning method for completing occluded anatomical structures in 3D ultrasound by leveraging complementary information from a single X-ray image. To enable training, we generate paired training data consisting of: (1) 2D lateral vertebral views that simulate X-ray scans, and (2) 3D partial vertebrae representations that mimic the limited visibility and occlusions encountered during ultrasound spine imaging. Our method integrates morphological information from both imaging modalities and demonstrates significant improvements in vertebral reconstruction (p < 0.001) compared to state of art in 3D ultrasound vertebral completion. We perform phantom studies as an initial step to future clinical translation, and achieve a more accurate, complete volumetric lumbar spine visualization overlayed on the ultrasound scan without the need for registration with preoperative modalities such as computed tomography. This demonstrates that integrating a single X-ray projection mitigates ultrasound's key limitation while preserving its strengths as the primary imaging modality. Code and data can be found at https://github.com/miruna20/US-X-Complete

From Linear Probing to Joint-Weighted Token Hierarchy: A Foundation Model Bridging Global and Cellular Representations in Biomarker Detection

AI-based biomarkers can infer molecular features directly from hematoxylin & eosin (H&E) slides, yet most pathology foundation models (PFMs) rely on global patch-level embeddings and overlook cell-level morphology. We present a PFM model, JWTH (Joint-Weighted Token Hierarchy), which integrates large-scale self-supervised pretraining with cell-centric post-tuning and attention pooling to fuse local and global tokens. Across four tasks involving four biomarkers and eight cohorts, JWTH achieves up to 8.3% higher balanced accuracy and 1.2% average improvement over prior PFMs, advancing interpretable and robust AI-based biomarker detection in digital pathology.

Foundation Visual Encoders Are Secretly Few-Shot Anomaly Detectors

Few-shot anomaly detection streamlines and simplifies industrial safety inspection. However, limited samples make accurate differentiation between normal and abnormal features challenging, and even more so under category-agnostic conditions. Large-scale pre-training of foundation visual encoders has advanced many fields, as the enormous quantity of data helps to learn the general distribution of normal images. We observe that the anomaly amount in an image directly correlates with the difference in the learnt embeddings and utilize this to design a few-shot anomaly detector termed FoundAD. This is done by learning a nonlinear projection operator onto the natural image manifold. The simple operator acts as an effective tool for anomaly detection to characterize and identify out-of-distribution regions in an image. Extensive experiments show that our approach supports multi-class detection and achieves competitive performance while using substantially fewer parameters than prior methods. Backed up by evaluations with multiple foundation encoders, including fresh DINOv3, we believe this idea broadens the perspective on foundation features and advances the field of few-shot anomaly detection.

CLAPS: A CLIP-Unified Auto-Prompt Segmentation for Multi-Modal Retinal Imaging

Recent advancements in foundation models, such as the Segment Anything Model (SAM), have significantly impacted medical image segmentation, especially in retinal imaging, where precise segmentation is vital for diagnosis. Despite this progress, current methods face critical challenges: 1) modality ambiguity in textual disease descriptions, 2) a continued reliance on manual prompting for SAM-based workflows, and 3) a lack of a unified framework, with most methods being modality- and task-specific. To overcome these hurdles, we propose CLIP-unified Auto-Prompt Segmentation (\CLAPS), a novel method for unified segmentation across diverse tasks and modalities in retinal imaging. Our approach begins by pre-training a CLIP-based image encoder on a large, multi-modal retinal dataset to handle data scarcity and distribution imbalance. We then leverage GroundingDINO to automatically generate spatial bounding box prompts by detecting local lesions. To unify tasks and resolve ambiguity, we use text prompts enhanced with a unique "modality signature" for each imaging modality. Ultimately, these automated textual and spatial prompts guide SAM to execute precise segmentation, creating a fully automated and unified pipeline. Extensive experiments on 12 diverse datasets across 11 critical segmentation categories show that CLAPS achieves performance on par with specialized expert models while surpassing existing benchmarks across most metrics, demonstrating its broad generalizability as a foundation model.

UOPSL: Unpaired OCT Predilection Sites Learning for Fundus Image Diagnosis Augmentation

Significant advancements in AI-driven multimodal medical image diagnosis have led to substantial improvements in ophthalmic disease identification in recent years. However, acquiring paired multimodal ophthalmic images remains prohibitively expensive. While fundus photography is simple and cost-effective, the limited availability of OCT data and inherent modality imbalance hinder further progress. Conventional approaches that rely solely on fundus or textual features often fail to capture fine-grained spatial information, as each imaging modality provides distinct cues about lesion predilection sites. In this study, we propose a novel unpaired multimodal framework \UOPSL that utilizes extensive OCT-derived spatial priors to dynamically identify predilection sites, enhancing fundus image-based disease recognition. Our approach bridges unpaired fundus and OCTs via extended disease text descriptions. Initially, we employ contrastive learning on a large corpus of unpaired OCT and fundus images while simultaneously learning the predilection sites matrix in the OCT latent space. Through extensive optimization, this matrix captures lesion localization patterns within the OCT feature space. During the fine-tuning or inference phase of the downstream classification task based solely on fundus images, where paired OCT data is unavailable, we eliminate OCT input and utilize the predilection sites matrix to assist in fundus image classification learning. Extensive experiments conducted on 9 diverse datasets across 28 critical categories demonstrate that our framework outperforms existing benchmarks.

UltrON: Ultrasound Occupancy Networks

In free-hand ultrasound imaging, sonographers rely on expertise to mentally integrate partial 2D views into 3D anatomical shapes. Shape reconstruction can assist clinicians in this process. Central to this task is the choice of shape representation, as it determines how accurately and efficiently the structure can be visualized, analyzed, and interpreted. Implicit representations, such as SDF and occupancy function, offer a powerful alternative to traditional voxel- or mesh-based methods by modeling continuous, smooth surfaces with compact storage, avoiding explicit discretization. Recent studies demonstrate that SDF can be effectively optimized using annotations derived from segmented B-mode ultrasound images. Yet, these approaches hinge on precise annotations, overlooking the rich acoustic information embedded in B-mode intensity. Moreover, implicit representation approaches struggle with the ultrasound's view-dependent nature and acoustic shadowing artifacts, which impair reconstruction. To address the problems resulting from occlusions and annotation dependency, we propose an occupancy-based representation and introduce \gls{UltrON} that leverages acoustic features to improve geometric consistency in weakly-supervised optimization regime. We show that these features can be obtained from B-mode images without additional annotation cost. Moreover, we propose a novel loss function that compensates for view-dependency in the B-mode images and facilitates occupancy optimization from multiview ultrasound. By incorporating acoustic properties, \gls{UltrON} generalizes to shapes of the same anatomy. We show that \gls{UltrON} mitigates the limitations of occlusions and sparse labeling and paves the way for more accurate 3D reconstruction. Code and dataset will be available at https://github.com/magdalena-wysocki/ultron.

GALA: Guided Attention with Language Alignment for Open Vocabulary Gaussian Splatting

3D scene reconstruction and understanding have gained increasing popularity, yet existing methods still struggle to capture fine-grained, language-aware 3D representations from 2D images. In this paper, we present GALA, a novel framework for open-vocabulary 3D scene understanding with 3D Gaussian Splatting (3DGS). GALA distills a scene-specific 3D instance feature field via self-supervised contrastive learning. To extend to generalized language feature fields, we introduce the core contribution of GALA, a cross-attention module with two learnable codebooks that encode view-independent semantic embeddings. This design not only ensures intra-instance feature similarity but also supports seamless 2D and 3D open-vocabulary queries. It reduces memory consumption by avoiding per-Gaussian high-dimensional feature learning. Extensive experiments on real-world datasets demonstrate GALA's remarkable open-vocabulary performance on both 2D and 3D.