PelviNeXt: A Modality-Agnostic Hybrid Network for Pelvic Imaging in Women's Health

Women's health remains substantially under-resourced in medical imaging research, with pelvic pathologies such as polycystic ovary syndrome (PCOS) and pelvic fracture both suffering from a scarcity of public, well-annotated benchmark data despite their clinical importance. We introduce PelviNeXt, a modality-agnostic hybrid architecture combining a dense convolutional feature extractor, hierarchical channel-spatial attention (H-CBAM), a multi-scale fusion module (MSFM), and talking-heads multi-head self-attention (TH-MHSA), applied without modification to both pelvic ultrasound and X-ray inputs. While benchmarking PelviNeXt on PCOSGen, the only gynaecologist-annotated public PCOS ultrasound dataset, we identified extensive exact and near-duplicate contamination within and across the dataset. We audit this contamination via perceptual hashing, publicly release a deduplicated version of the dataset, and establish the first integrity-audited evaluation protocol and baseline for PCOSGen under 5-fold cross-validation. On the only publicly available pelvic fracture X-ray dataset (PXR150), PelviNeXt exceeds previously reported state-of-the-art results across accuracy, recall, specificity, and AUROC. Ablation studies confirm that each architectural component contributes to performance on both tasks. Our results demonstrate that a single architecture, applied without task-specific modification, can serve as a reliable foundation for pelvic imaging across modalities in data-scarce, under-researched areas of women's health.

SecondOpinion: Anatomy-Aware Gated Reasoning for Efficient Medical Image Analysis

Deep learning models for medical image analysis typically apply a fixed amount of computation to every input, regardless of case difficulty. Anatomy-guided dual-stream architectures have been shown to improve diagnostic performance, but they evaluate both streams unconditionally, even on cases a single stream could already resolve confidently. We propose SecondOpinion, a framework in which a fast primary stream processes every case, while a second, anatomy-guided stream is invoked only when GateKeeper, a gating mechanism trained explicitly as a binary correctness classifier, judges that the primary stream's prediction needs additional scrutiny, much as a clinician might seek a second opinion on a difficult case. When activated, the two streams are combined through a lightweight cross-attention fusion module. We evaluate SecondOpinion on a unified five-class chest X-ray dataset and a pelvic fracture dataset, the latter including a held-out, harder subset of fractures that are invisible on X-ray but confirmed via CT. SecondOpinion matches or exceeds prior state-of-the-art performance on both tasks, while activating its anatomy-guided stream on only 9.23% of chest X-ray cases, rising to 24.12% on visible fractures and 45.71% on invisible fractures, an activation rate that tracks task difficulty directly. These results suggest that supervising a gating signal toward correctness, rather than relying on unsupervised confidence, allows a model to allocate anatomical reasoning where it is actually needed.

Route, Retrieve, Reflect, Repair: Self-Improving Agentic Framework for Visual Detection and Linguistic Reasoning in Medical Imaging

Medical image analysis increasingly relies on large vision-language models (VLMs), yet most systems remain single-pass black boxes that offer limited control over reasoning, safety, and spatial grounding. We propose R^4, an agentic framework that decomposes medical imaging workflows into four coordinated agents: a Router that configures task- and specialization-aware prompts from the image, patient history, and metadata; a Retriever that uses exemplar memory and pass@k sampling to jointly generate free-text reports and bounding boxes; a Reflector that critiques each draft-box pair for key clinical error modes (negation, laterality, unsupported claims, contradictions, missing findings, and localization errors); and a Repairer that iteratively revises both narrative and spatial outputs under targeted constraints while curating high-quality exemplars for future cases. Instantiated on chest X-ray analysis with multiple modern VLM backbones and evaluated on report generation and weakly supervised detection, R^4 consistently boosts LLM-as-a-Judge scores by roughly +1.7-+2.5 points and mAP50 by +2.5-+3.5 absolute points over strong single-VLM baselines, without any gradient-based fine-tuning. These results show that agentic routing, reflection, and repair can turn strong but brittle VLMs into more reliable and better grounded tools for clinical image interpretation. Our code can be found at: https://github.com/faiyazabdullah/MultimodalMedAgent

Invisible Yet Detected: PelFANet with Attention-Guided Anatomical Fusion for Pelvic Fracture Diagnosis

Pelvic fractures pose significant diagnostic challenges, particularly in cases where fracture signs are subtle or invisible on standard radiographs. To address this, we introduce PelFANet, a dual-stream attention network that fuses raw pelvic X-rays with segmented bone images to improve fracture classification. The network em-ploys Fused Attention Blocks (FABlocks) to iteratively exchange and refine fea-tures from both inputs, capturing global context and localized anatomical detail. Trained in a two-stage pipeline with a segmentation-guided approach, PelFANet demonstrates superior performance over conventional methods. On the AMERI dataset, it achieves 88.68% accuracy and 0.9334 AUC on visible fractures, while generalizing effectively to invisible fracture cases with 82.29% accuracy and 0.8688 AUC, despite not being trained on them. These results highlight the clini-cal potential of anatomy-aware dual-input architectures for robust fracture detec-tion, especially in scenarios with subtle radiographic presentations.