Female-RHINO: A Real-Time Scanner-Integrated Framework for Automated Quantitative Uterine MRI Analysis and Structured Reporting

Standardized assessment of uterine MRI remains challenging due to anatomical variability, observer dependence, and the lack of workflow-integrated automated analysis tools. This work presents Female-RHINO: (R)eproductive (H)ealth (I)maging A(N)alysis T(O)ol, a real-time AI-assisted framework for automated quantitative uterine MRI analysis and structured reporting during image acquisition. We present an end-to-end system that integrates inline communication with the MRI scanner and deep learning-based analysis to derive quantitative uterine biomarkers from sagittal T2-weighted pelvic MRI. The framework combines segmentation and anatomical landmark detection models trained and evaluated on more than 500 multi-center datasets spanning diverse protocols, vendors, and patient populations. It performs volumetry, detects and quantifies common incidental findings such as fibroids and Nabothian cysts, and extracts six anatomical landmarks for biometric assessment. Results are compiled into a structured clinician-oriented report with integrated visualizations, without manual interaction. Evaluation on independent retrospective and prospective cohorts demonstrated robust performance across varying acquisition settings. Mean Dice similarity coefficients were 0.82 for the uterus and 0.80 for fibroids, with lower but consistent agreement for Nabothian cysts. Landmark detection achieved a mean radial error of 3.7 mm. End-to-end processing was completed in under 70 seconds, enabling availability of results during the ongoing scan. Prospective deployment yielded immediate, standardized, and reproducible analyses supported by inter-observer agreement. The proposed system enables real-time scanner-integrated AI for automated uterine MRI analysis and reporting, with potential to improve standardization, efficiency, and clinical workflow in pelvic imaging.

Benchmark Success, Clinical Failure: When Reinforcement Learning Optimizes for Benchmarks, Not Patients

Recent Reinforcement Learning (RL) advances for Large Language Models (LLMs) have improved reasoning tasks, yet their resource-constrained application to medical imaging remains underexplored. We introduce ChexReason, a vision-language model trained via R1-style methodology (SFT followed by GRPO) using only 2,000 SFT samples, 1,000 RL samples, and a single A100 GPU. Evaluations on CheXpert and NIH benchmarks reveal a fundamental tension: GRPO recovers in-distribution performance (23% improvement on CheXpert, macro-F1 = 0.346) but degrades cross-dataset transferability (19% drop on NIH). This mirrors high-resource models like NV-Reason-CXR-3B, suggesting the issue stems from the RL paradigm rather than scale. We identify a generalization paradox where the SFT checkpoint uniquely improves on NIH before optimization, indicating teacher-guided reasoning captures more institution-agnostic features. Furthermore, cross-model comparisons show structured reasoning scaffolds benefit general-purpose VLMs but offer minimal gain for medically pre-trained models. Consequently, curated supervised fine-tuning may outperform aggressive RL for clinical deployment requiring robustness across diverse populations.