Evo-RAD: Navigating Rare Retinal Disease Diagnosis via Self-Evolving Agentic Retrieval

Large-scale pretrained foundation models have revolutionized general medical screening, but often falter on rare diseases because such conditions are underrepresented in real-world clinical datasets. While retrieval-augmented diagnosis attempts to mitigate this, conventional static methods frequently succumb to the hubness problem, retrieving visually similar but semantically incorrect common diseases. To address this, we propose Evo-RAD, a self-evolving agentic framework that transforms evidence acquisition into a dynamic decision-making task. We formulate retrieval as a Markov Decision Process (MDP) where a graphbased agent observes the reference set state and executes actions to purge discordant evidence (DELETE), acquire pathologically consistent samples (INSERT), or conclude the evolution (TERMINATE). Optimized via Group Relative Policy Optimization (GRPO) with a homogeneityaware reward, the agent learns to maximize the diagnostic homogeneity of the support reference set. Experiments on retinal disease benchmarks show that Evo-RAD substantially improves rare-disease diagnosis, outperforming retinal foundation models by +21.04%, while also surpassing retrieval-based and parameter-efficient fine-tuning methods by +3.56%. Code is available at https://github.com/SDH-Lab/Evo-RAD.

DenseControl: Instance-Level Controllable Synthesis of Dense Crowd Image

In this paper, we introduce DenseControl, a novel pipeline for generating dense crowd images. Specifically, DenseControl meticulously positions and sizes each generated instance to align precisely with the predefined coordinates and scales. Based on this, we further allow for control over the background, style, and attributes of instances. The motivation behind DenseControl stems from the observation of two main challenges in synthesizing crowd images: controlling signal embedding and maintaining topological integrity when imparting instance scale guidance. To address these, we first introduce the Isolated Object Embedding (IOE) map, a novel representation that facilitates spatial location control while mitigating the difficulties associated with learning projections for model. Secondly, we propose an Implicit Scale Embedding (ISE) strategy that seamlessly integrates with the IOE map to encode precise scale information. To further enhance the efficacy of combining ISE with the IOE map, we incorporate a Position Shortcut mechanism that enhances cross-attention to alleviate projection challenges. We evaluate DenseControl through two lenses: synthesis quality and applicability in latent applications. Experiments across different control conditions demonstrate DenseControl achieves state-of-the-art results in dense crowd image synthesis. Furthermore, we showcase applications in augmenting crowd analysis under data scarcity, transfer learning, and weather generalization scenes, to highlight the practical utility of DenseControl. The codebase will be released.

JMed48k: A Multi-Profession Japanese Medical Licensing Benchmark for Vision-Language Model Evaluation

We introduce JMed48k, a multi-profession Japanese healthcare licensing benchmark for evaluating vision-language models. Built from official PDF materials released by the Japanese Ministry of Health, Labour and Welfare, JMed48k contains 48,862 exam questions and 20,142 images from 11 national licensing examinations between 2005 and 2025, with visual content annotated under an 8-type taxonomy. From this corpus, we derive JMed48k-Eval, a recent five-year evaluation subset with 12,484 scored questions, including 9,905 text-only questions and 2,579 questions with images. We evaluate 21 proprietary, open-source, and medical-specific models, reporting text-only and with-image performance separately. Because these subsets contain different questions, we further introduce a paired image-removal audit that evaluates questions with images before and after removing visual content to explore four answer-transition states. The audit shows that proprietary and open source models gain substantially from images, whereas medical-specific systems show limited observable use of visual evidence, with many correct answers persisting after image removal. Even among proprietary models, the net image-removal effect varies sevenfold across professions, from +5.7 points on Physician questions to +39.8 points on Public Health Nurse questions. We release JMed48k to support reproducible, profession-stratified evaluation of vision-language models in medical licensing settings.

NEWTON: Agentic Planning for Physically Grounded Video Generation

Video generation models produce visually compelling results but systematically violate physical commonsense -- on VideoPhy-2, the best model achieves only 32.6% joint accuracy. We identify a specification bottleneck: text prompts are lossy compression of the physical world, omitting the parameters that fully determine dynamics, and no amount of model scaling can recover what was never specified. From this diagnosis we derive three properties that physics conditioning must satisfy -- sufficiency, dynamism, and verifiability -- and show that no existing approach satisfies all three. We present NEWTON, in which video generation is demoted from the system output to one action inside an agent's toolbox: a learned planner orchestrates physics-aware tools (keyframe generation, scientific computation, prompt refinement) to construct rich conditioning, and a verifier closes the loop for iterative re-planning. The planner is the sole trainable component, optimized on-policy via Flow-GRPO inside the live multi-turn loop. On VideoPhy-2, NEWTON improves joint accuracy from 21.4% to 29.7% on LTX-Video and from 30.7% to 37.4% on Veo-3.1, without modifying either generator. Our project page: https://Newton026.github.io/newton

PRA-PoE: Robust Alzheimer's Diagnosis with Arbitrary Missing Modalities

Missing modalities are prevalent in real-world Alzheimer's disease (AD) assessment and pose a significant challenge to multimodal learning, particularly when the distribution of observed modality subsets differs between training and deployment. Such missingness pattern mismatch induces a conditional representation shift across modality subsets. Existing approaches that rely on implicit imputation or modality synthesis often fail to explicitly model modality availability and uncertainty, leading to overconfident dependence on synthesized features, reduced robustness, and miscalibrated uncertainty estimates. To address these limitations, we propose PRA-PoE, an incomplete multimodal learning framework that is equipped with Prototype-anchored Representation Alignment (PRA) and an Uncertainty-aware Product of Experts (UA-PoE) fusion mechanism. First, PRA uses learnable global prototypes and availability-conditioned tokens to encode modality availability, distinguish observed from missing modalities, re-synthesize features for missing modalities, and adaptively refine observed representations to align latent spaces across modality subsets, with the goal of reducing representation shift under varying missingness patterns. Second, UA-PoE models each modality as a Gaussian expert and performs closed-form Product of Experts fusion, where experts with higher uncertainty are automatically down-weighted via lower precision, improving uncertainty reliability. We evaluate PRA-PoE under a clinically realistic protocol by training with naturally missing data and testing on all non-empty modality combinations. PRA-PoE consistently outperforms the state-of-the-art across datasets, achieving a 5.4% relative improvement in average accuracy on ADNI and a 10.9% relative gain in average F1 on OASIS-3 over the strongest baseline across all non-empty modality subsets.

BrainAnytime: Anatomy-Aware Cross-Modal Pretraining for Brain Image Analysis with Arbitrary Modality Availability

Clinical diagnostic workups typically follow a modality escalation pathway: after initial clinical evaluation, clinicians begin with routine structural imaging (e.g., MRI), selectively add sequences such as FLAIR or T2 to refine the differential, and reserve molecular imaging (e.g., amyloid-PET) for cases that remain uncertain after standard evaluation. Consequently, patients are observed with heterogeneous and often incomplete modality subsets. However, most current AI models assume fixed data modalities as the model inputs. In this paper, we present BrainAnytime, a unified pretraining framework pretrained on 34,899 3D brain scans from five datasets that support brain image analysis under arbitrary modality availability spanning multi-sequence MRI and amyloid-PET. A single model accepts whatever imaging is available, from a lone T1 scan to a full multimodal workup. Pretraining learns structural-molecular correspondences between MRI and PET via cross-modal distillation (RCMD) and prioritizes disease-vulnerable anatomy via atlas-guided curriculum masking (PACM), all within a shared 3D masked autoencoder (Multi-MAE3D). Across four downstream tasks and five clinically motivated modality settings, BrainAnytime largely outperforms modality-specific models, missing-modality baselines, and large-scale brain MRI pretrained foundation models on most modality settings. Notably, it surpasses the strongest missing-modality baselines with relative improvements of 6.2% and 7.0% in average accuracy on CN vs. AD and CN vs. MCI classification, respectively. Code is available at https://github.com/SDH-Lab/BrainAnytime.

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.

AD-CARE: A Guideline-grounded, Modality-agnostic LLM Agent for Real-world Alzheimer's Disease Diagnosis with Multi-cohort Assessment, Fairness Analysis, and Reader Study

Alzheimer's disease (AD) is a growing global health challenge as populations age, and timely, accurate diagnosis is essential to reduce individual and societal burden. However, real-world AD assessment is hampered by incomplete, heterogeneous multimodal data and variability across sites and patient demographics. Although large language models (LLMs) have shown promise in biomedicine, their use in AD has largely been confined to answering narrow, disease-specific questions rather than generating comprehensive diagnostic reports that support clinical decision-making. Here we expand LLM capabilities for clinical decision support by introducing AD-CARE, a modality-agnostic agent that performs guideline-grounded diagnostic assessment from incomplete, heterogeneous inputs without imputing missing modalities. By dynamically orchestrating specialized diagnostic tools and embedding clinical guidelines into LLM-driven reasoning, AD-CARE generates transparent, report-style outputs aligned with real-world clinical workflows. Across six cohorts comprising 10,303 cases, AD-CARE achieved 84.9% diagnostic accuracy, delivering 4.2%-13.7% relative improvements over baseline methods. Despite cohort-level differences, dataset-specific accuracies remain robust (80.4%-98.8%), and the agent consistently outperforms all baselines. AD-CARE reduced performance disparities across racial and age subgroups, decreasing the average dispersion of four metrics by 21%-68% and 28%-51%, respectively. In a controlled reader study, the agent improved neurologist and radiologist accuracy by 6%-11% and more than halved decision time. The framework yielded 2.29%-10.66% absolute gains over eight backbone LLMs and converges their performance. These results show that AD-CARE is a scalable, practically deployable framework that can be integrated into routine clinical workflows for multimodal decision support in AD.

Moving Beyond Functional Connectivity: Time-Series Modeling for fMRI-Based Brain Disorder Classification

Functional magnetic resonance imaging (fMRI) enables non-invasive brain disorder classification by capturing blood-oxygen-level-dependent (BOLD) signals. However, most existing methods rely on functional connectivity (FC) via Pearson correlation, which reduces 4D BOLD signals to static 2D matrices, discarding temporal dynamics and capturing only linear inter-regional relationships. In this work, we benchmark state-of-the-art temporal models (e.g., time-series models such as PatchTST, TimesNet, and TimeMixer) on raw BOLD signals across five public datasets. Results show these models consistently outperform traditional FC-based approaches, highlighting the value of directly modeling temporal information such as cycle-like oscillatory fluctuations and drift-like slow baseline trends. Building on this insight, we propose DeCI, a simple yet effective framework that integrates two key principles: (i) Cycle and Drift Decomposition to disentangle cycle and drift within each ROI (Region of Interest); and (ii) Channel-Independence to model each ROI separately, improving robustness and reducing overfitting. Extensive experiments demonstrate that DeCI achieves superior classification accuracy and generalization compared to both FC-based and temporal baselines. Our findings advocate for a shift toward end-to-end temporal modeling in fMRI analysis to better capture complex brain dynamics. The code is available at https://github.com/Levi-Ackman/DeCI.

Guided by the Plan: Enhancing Faithful Autoregressive Text-to-Audio Generation with Guided Decoding

Autoregressive (AR) models excel at generating temporally coherent audio by producing tokens sequentially, yet they often falter in faithfully following complex textual prompts, especially those describing complex sound events. We uncover a surprising capability in AR audio generators: their early prefix tokens implicitly encode global semantic attributes of the final output, such as event count and sound-object category, revealing a form of implicit planning. Building on this insight, we propose Plan-Critic, a lightweight auxiliary model trained with a Generalized Advantage Estimation (GAE)-inspired objective to predict final instruction-following quality from partial generations. At inference time, Plan-Critic enables guided exploration: it evaluates candidate prefixes early, prunes low-fidelity trajectories, and reallocates computation to high-potential planning seeds. Our Plan-Critic-guided sampling achieves up to a 10-point improvement in CLAP score over the AR baseline-establishing a new state of the art in AR text-to-audio generation-while maintaining computational parity with standard best-of-N decoding. This work bridges the gap between causal generation and global semantic alignment, demonstrating that even strictly autoregressive models can plan ahead.