Architecture-Aware Reinforcement Learning Makes Sliding-Window Attention Competitive in Math Reasoning

The rapid progress of reasoning and agentic large language models (LLMs) has increased the demand for long-context inference, but self-attention (SA) scales quadratically with context length. To address this, we study SWARR (Sliding-Window Attention with Reinforced Adaptation for Math Reasoning), a practical recipe for adapting SWA models to mathematical reasoning. SWARR has two stages: (1) efficient conversion from a pretrained SA model to SWA with supervised fine-tuning (SFT), which avoids pretraining a new base model, and (2) policy adaptation with reinforcement learning (RL). We find that SWA still underperforms SA after SFT, and we hypothesize that this gap is caused in part by a data-architecture mismatch: most SFT data are prepared for SA models and may contain long-range dependencies that are difficult for SWA to model. Because on-policy RL optimizes self-generated trajectories under the SWA constraint, it can adapt trajectories to better match SWA. Experiments on mathematical reasoning benchmarks show that this recipe substantially narrows the gap between SWA and SA, recovering much of the accuracy lost during SWA conversion while preserving the efficiency benefits of linear-complexity attention. Our central contribution is the empirical finding that RL changes the conclusion one would draw from conversion and SFT alone about SWA's viability for math reasoning.

A unified multi-task framework enables interpretable chest radiograph analysis

While multimodal deep learning has advanced medical imaging analysis, existing black-box systems \textcolor{black}{may remain confined to isolated tasks, often overlooking} the trust-sensitive nature of clinical diagnosis as a multi-task process. We propose IMT-CXR (Interpretable Multi-task Transformer for Chest X-ray Analysis), a framework that emulates radiologists' diagnostic workflow through three evidence-driven stages: 1) Disease recognition; 2) Attribute characterization (e.g., size, location, severity quantification); 3) Evidence-integrated report generation with traceable decision pathways. The framework employs a unified transformer architecture optimized via medical-domain instruction tuning, sequentially executing four clinical tasks: multi-label disease classification, lesion localization, anatomical segmentation, and radiology report generation. Experimental validation demonstrates competitive performance on ten CXR benchmarks under direct inference and fine-tuning settings. In a blinded evaluation of 160 historical reports from four medical centers, three radiologists rated 66\% of AI-generated reports as comparable to or surpassing original clinical reports in diagnostic clarity, highlighting the framework's translational potential. By establishing traceable diagnostic pathways from anatomical findings to conclusions, this work bridges the gap between AI technical metrics and clinical utility, advancing trustworthy AI systems in medical imaging.

Project Imaging-X: A Survey of 1000+ Open-Access Medical Imaging Datasets for Foundation Model Development

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

Human-AI Co-reasoning for Clinical Diagnosis with Evidence-Integrated Language Agent

We present PULSE, a medical reasoning agent that combines a domain-tuned large language model with scientific literature retrieval to support diagnostic decision-making in complex real-world cases. To evaluate its capabilities, we curated a benchmark of 82 authentic endocrinology case reports encompassing a broad spectrum of disease types and incidence levels. In controlled experiments, we compared PULSE's performance against physicians with varying levels of expertise-from residents to senior specialists-and examined how AI assistance influenced human diagnostic reasoning. PULSE attained expert-competitive accuracy, outperforming residents and junior specialists while matching senior specialist performance at both Top@1 and Top@4 thresholds. Unlike physicians, whose accuracy declined with disease rarity, PULSE maintained stable performance across incidence tiers. The agent also exhibited adaptive reasoning, increasing output length with case difficulty in a manner analogous to the longer deliberation observed among expert clinicians. When used collaboratively, PULSE enabled physicians to correct initial errors and broaden diagnostic hypotheses, but also introduced risks of automation bias. The study explores both serial and concurrent collaboration workflows, revealing that PULSE offers robust support across common and rare presentations. These findings underscore both the promise and the limitations of language model-based agents in clinical diagnosis, and offer a framework for evaluating their role in real-world decision-making.

MADCrowner: Margin Aware Dental Crown Design with Template Deformation and Refinement

Dental crown restoration is one of the most common treatment modalities for tooth defect, where personalized dental crown design is critical. While computer-aided design (CAD) systems have notably enhanced the efficiency of dental crown design, extensive manual adjustments are still required in the clinic workflow. Recent studies have explored the application of learning-based methods for the automated generation of restorative dental crowns. Nevertheless, these approaches were challenged by inadequate spatial resolution, noisy outputs, and overextension of surface reconstruction. To address these limitations, we propose \totalframework, a margin-aware mesh generation framework comprising CrownDeformR and CrownSegger. Inspired by the clinic manual workflow of dental crown design, we designed CrownDeformR to deform an initial template to the target crown based on anatomical context, which is extracted by a multi-scale intraoral scan encoder. Additionally, we introduced \marginseg, a novel margin segmentation network, to extract the cervical margin of the target tooth. The performance of CrownDeformR improved with the cervical margin as an extra constraint. And it was also utilized as the boundary condition for the tailored postprocessing method, which removed the overextended area of the reconstructed surface. We constructed a large-scale intraoral scan dataset and performed extensive experiments. The proposed method significantly outperformed existing approaches in both geometric accuracy and clinical feasibility.

RAFM: Retrieval-Augmented Flow Matching for Unpaired CBCT-to-CT Translation

Cone-beam CT (CBCT) is routinely acquired in radiotherapy but suffers from severe artifacts and unreliable Hounsfield Unit (HU) values, limiting its direct use for dose calculation. Synthetic CT (sCT) generation from CBCT is therefore an important task, yet paired CBCT--CT data are often unavailable or unreliable due to temporal gaps, anatomical variation, and registration errors. In this work, we introduce rectified flow (RF) into unpaired CBCT-to-CT translation in medical imaging. Although RF is theoretically compatible with unpaired learning through distribution-level coupling and deterministic transport, its practical effectiveness under small medical datasets and limited batch sizes remains underexplored. Direct application with random or batch-local pseudo pairing can produce unstable supervision due to semantically mismatched endpoint samples. To address this challenge, we propose Retrieval-Augmented Flow Matching (RAFM), which adapts RF to the medical setting by constructing retrieval-guided pseudo pairs using a frozen DINOv3 encoder and a global CT memory bank. This strategy improves empirical coupling quality and stabilizes unpaired flow-based training. Experiments on SynthRAD2023 under a strict subject-level true-unpaired protocol show that RAFM outperforms existing methods across FID, MAE, SSIM, PSNR, and SegScore. The code is available at https://github.com/HiLab-git/RAFM.git.

A3-TTA: Adaptive Anchor Alignment Test-Time Adaptation for Image Segmentation

Test-Time Adaptation (TTA) offers a practical solution for deploying image segmentation models under domain shift without accessing source data or retraining. Among existing TTA strategies, pseudo-label-based methods have shown promising performance. However, they often rely on perturbation-ensemble heuristics (e.g., dropout sampling, test-time augmentation, Gaussian noise), which lack distributional grounding and yield unstable training signals. This can trigger error accumulation and catastrophic forgetting during adaptation. To address this, we propose \textbf{A3-TTA}, a TTA framework that constructs reliable pseudo-labels through anchor-guided supervision. Specifically, we identify well-predicted target domain images using a class compact density metric, under the assumption that confident predictions imply distributional proximity to the source domain. These anchors serve as stable references to guide pseudo-label generation, which is further regularized via semantic consistency and boundary-aware entropy minimization. Additionally, we introduce a self-adaptive exponential moving average strategy to mitigate label noise and stabilize model update during adaptation. Evaluated on both multi-domain medical images (heart structure and prostate segmentation) and natural images, A3-TTA significantly improves average Dice scores by 10.40 to 17.68 percentage points compared to the source model, outperforming several state-of-the-art TTA methods under different segmentation model architectures. A3-TTA also excels in continual TTA, maintaining high performance across sequential target domains with strong anti-forgetting ability. The code will be made publicly available at https://github.com/HiLab-git/A3-TTA.

EHRWorld: A Patient-Centric Medical World Model for Long-Horizon Clinical Trajectories

World models offer a principled framework for simulating future states under interventions, but realizing such models in complex, high-stakes domains like medicine remains challenging. Recent large language models (LLMs) have achieved strong performance on static medical reasoning tasks, raising the question of whether they can function as dynamic medical world models capable of simulating disease progression and treatment outcomes over time. In this work, we show that LLMs only incorporating medical knowledge struggle to maintain consistent patient states under sequential interventions, leading to error accumulation in long-horizon clinical simulation. To address this limitation, we introduce EHRWorld, a patient-centric medical world model trained under a causal sequential paradigm, together with EHRWorld-110K, a large-scale longitudinal clinical dataset derived from real-world electronic health records. Extensive evaluations demonstrate that EHRWorld significantly outperforms naive LLM-based baselines, achieving more stable long-horizon simulation, improved modeling of clinically sensitive events, and favorable reasoning efficiency, highlighting the necessity of training on causally grounded, temporally evolving clinical data for reliable and robust medical world modeling.

MedMCP-Calc: Benchmarking LLMs for Realistic Medical Calculator Scenarios via MCP Integration

Medical calculators are fundamental to quantitative, evidence-based clinical practice. However, their real-world use is an adaptive, multi-stage process, requiring proactive EHR data acquisition, scenario-dependent calculator selection, and multi-step computation, whereas current benchmarks focus only on static single-step calculations with explicit instructions. To address these limitations, we introduce MedMCP-Calc, the first benchmark for evaluating LLMs in realistic medical calculator scenarios through Model Context Protocol (MCP) integration. MedMCP-Calc comprises 118 scenario tasks across 4 clinical domains, featuring fuzzy task descriptions mimicking natural queries, structured EHR database interaction, external reference retrieval, and process-level evaluation. Our evaluation of 23 leading models reveals critical limitations: even top performers like Claude Opus 4.5 exhibit substantial gaps, including difficulty selecting appropriate calculators for end-to-end workflows given fuzzy queries, poor performance in iterative SQL-based database interactions, and marked reluctance to leverage external tools for numerical computation. Performance also varies considerably across clinical domains. Building on these findings, we develop CalcMate, a fine-tuned model incorporating scenario planning and tool augmentation, achieving state-of-the-art performance among open-source models. Benchmark and Codes are available in https://github.com/SPIRAL-MED/MedMCP-Calc.

SegRap2025: A Benchmark of Gross Tumor Volume and Lymph Node Clinical Target Volume Segmentation for Radiotherapy Planning of Nasopharyngeal Carcinoma

Accurate delineation of Gross Tumor Volume (GTV), Lymph Node Clinical Target Volume (LN CTV), and Organ-at-Risk (OAR) from Computed Tomography (CT) scans is essential for precise radiotherapy planning in Nasopharyngeal Carcinoma (NPC). Building upon SegRap2023, which focused on OAR and GTV segmentation using single-center paired non-contrast CT (ncCT) and contrast-enhanced CT (ceCT) scans, the SegRap2025 challenge aims to enhance the generalizability and robustness of segmentation models across imaging centers and modalities. SegRap2025 comprises two tasks: Task01 addresses GTV segmentation using paired CT from the SegRap2023 dataset, with an additional external testing set to evaluate cross-center generalization, and Task02 focuses on LN CTV segmentation using multi-center training data and an unseen external testing set, where each case contains paired CT scans or a single modality, emphasizing both cross-center and cross-modality robustness. This paper presents the challenge setup and provides a comprehensive analysis of the solutions submitted by ten participating teams. For GTV segmentation task, the top-performing models achieved average Dice Similarity Coefficient (DSC) of 74.61% and 56.79% on the internal and external testing cohorts, respectively. For LN CTV segmentation task, the highest average DSC values reached 60.24%, 60.50%, and 57.23% on paired CT, ceCT-only, and ncCT-only subsets, respectively. SegRap2025 establishes a large-scale multi-center, multi-modality benchmark for evaluating the generalization and robustness in radiotherapy target segmentation, providing valuable insights toward clinically applicable automated radiotherapy planning systems. The benchmark is available at: https://hilab-git.github.io/SegRap2025_Challenge.