Seeing Through the Tool: A Controlled Benchmark for Occlusion Robustness in Foundation Segmentation Models

Occlusion, where target structures are partially hidden by surgical instruments or overlapping tissues, remains a critical yet underexplored challenge for foundation segmentation models in clinical endoscopy. We introduce OccSAM-Bench, a benchmark designed to systematically evaluate SAM-family models under controlled, synthesized surgical occlusion. Our framework simulates two occlusion types (i.e., surgical tool overlay and cutout) across three calibrated severity levels on three public polyp datasets. We propose a novel three-region evaluation protocol that decomposes segmentation performance into full, visible-only, and invisible targets. This metric exposes behaviors that standard amodal evaluation obscures, revealing two distinct model archetypes: Occluder-Aware models (SAM, SAM 2, SAM 3, MedSAM3), which prioritize visible tissue delineation and reject instruments, and Occluder-Agnostic models (MedSAM, MedSAM2), which confidently predict into occluded regions. SAM-Med2D aligns with neither and underperforms across all conditions. Ultimately, our results demonstrate that occlusion robustness is not uniform across architectures, and model selection must be driven by specific clinical intent-whether prioritizing conservative visible-tissue segmentation or the amodal inference of hidden anatomy.

GazeVaLM: A Multi-Observer Eye-Tracking Benchmark for Evaluating Clinical Realism in AI-Generated X-Rays

We introduce GazeVaLM, a public eye-tracking dataset for studying clinical perception during chest radiograph authenticity assessment. The dataset comprises 960 gaze recordings from 16 expert radiologists interpreting 30 real and 30 synthetic chest X-rays (generated by diffusion based generative AI) under two conditions: diagnostic assessment and real-fake classification (Visual Turing test). For each image-observer pair, we provide raw gaze samples, fixation maps, scanpaths, saliency density maps, structured diagnostic labels, and authenticity judgments. We extend the protocol to 6 state-of-the-art multimodal LLMs, releasing their predicted diagnoses, authenticity labels, and confidence scores under matched conditions - enabling direct human-AI comparison at both decision and uncertainty levels. We further provide analyses of gaze agreement, inter-observer consistency, and benchmarking of radiologists versus LLMs in diagnostic accuracy and authenticity detection. GazeVaLM supports research in gaze modeling, clinical decision-making, human-AI comparison, generative image realism assessment, and uncertainty quantification. By jointly releasing visual attention data, clinical labels, and model predictions, we aim to facilitate reproducible research on how experts and AI systems perceive, interpret, and evaluate medical images. The dataset is available at https://huggingface.co/datasets/davidcwong/GazeVaLM.

What They Saw, Not Just Where They Looked: Semantic Scanpath Similarity via VLMs and NLP metric

Scanpath similarity metrics are central to eye-movement research, yet existing methods predominantly evaluate spatial and temporal alignment while neglecting semantic equivalence between attended image regions. We present a semantic scanpath similarity framework that integrates vision-language models (VLMs) into eye-tracking analysis. Each fixation is encoded under controlled visual context (patch-based and marker-based strategies) and transformed into concise textual descriptions, which are aggregated into scanpath-level representations. Semantic similarity is then computed using embedding-based and lexical NLP metrics and compared against established spatial measures, including MultiMatch and DTW. Experiments on free-viewing eye-tracking data demonstrate that semantic similarity captures partially independent variance from geometric alignment, revealing cases of high content agreement despite spatial divergence. We further analyze the impact of contextual encoding on description fidelity and metric stability. Our findings suggest that multimodal foundation models enable interpretable, content-aware extensions of classical scanpath analysis, providing a complementary dimension for gaze research within the ETRA community.

CORA: A Pathology Synthesis Driven Foundation Model for Coronary CT Angiography Analysis and MACE Risk Assessment

Coronary artery disease, the leading cause of cardiovascular mortality worldwide, can be assessed non-invasively by coronary computed tomography angiography (CCTA). Despite progress in automated CCTA analysis using deep learning, clinical translation is constrained by the scarcity of expert-annotated datasets. Furthermore, widely adopted label-free pretraining strategies, such as masked image modeling, are intrinsically biased toward global anatomical statistics, frequently failing to capture the spatially localized pathological features of coronary plaques. Here, we introduce CORA, a 3D vision foundation model for comprehensive cardiovascular risk assessment. CORA learns directly from volumetric CCTA via a pathology-centric, synthesis-driven self-supervised framework. By utilizing an anatomy-guided lesion synthesis engine, the model is explicitly trained to detect simulated vascular abnormalities, biasing representation learning toward clinically relevant disease features rather than dominant background anatomy. We trained CORA on a large-scale cohort of 12,801 unlabeled CCTA volumes and comprehensively evaluated the model across multi-center datasets from nine independent hospitals. Across diagnostic and anatomical tasks, including plaque characterization, stenosis detection, and coronary artery segmentation, CORA consistently outperformed the state-of-the-art 3D vision foundation models, achieving up to a 29\% performance gain. Crucially, by coupling the imaging encoder with a large language model, we extended CORA into a multimodal framework that significantly improved 30-day major adverse cardiac event (MACE) risk stratification. Our results establish CORA as a scalable and extensible foundation for unified anatomical assessment and cardiovascular risk prediction.

LUMINA: A Multi-Vendor Mammography Benchmark with Energy Harmonization Protocol

Publicly available full-field digital mammography (FFDM) datasets remain limited in size, clinical annotations, and vendor diversity, hindering the development of robust models. We introduce LUMINA, a curated, multi-vendor FFDM dataset that explicitly encodes acquisition energy and vendor metadata to capture clinically relevant appearance variations often overlooked in existing benchmarks. This dataset contains 1824 images from 468 patients (960 benign, 864 malignant), with pathology-confirmed labels, BI-RADS assessments, and breast-density annotations. LUMINA spans six acquisition systems and includes both high- and low-energy imaging styles, enabling systematic analysis of vendor- and energy-induced domain shifts. To address these variations, we propose a foreground-only pixel-space alignment method (''energy harmonization'') that maps images to a low-energy reference while preserving lesion morphology. We benchmark CNN and transformer models on three clinically relevant tasks: diagnosis (benign vs. malignant), BI-RADS classification, and density estimation. Two-view models consistently outperform single-view models. EfficientNet-B0 achieves an AUC of 93.54% for diagnosis, while Swin-T achieves the best macro-AUC of 89.43% for density prediction. Harmonization improves performance across architectures and produces more localized Grad-CAM responses. Overall, LUMINA provides (1) a vendor-diverse benchmark and (2) a model-agnostic harmonization framework for reliable and deployable mammography AI.

Beyond Medical Diagnostics: How Medical Multimodal Large Language Models Think in Space

Visual spatial intelligence is critical for medical image interpretation, yet remains largely unexplored in Multimodal Large Language Models (MLLMs) for 3D imaging. This gap persists due to a systemic lack of datasets featuring structured 3D spatial annotations beyond basic labels. In this study, we introduce an agentic pipeline that autonomously synthesizes spatial visual question-answering (VQA) data by orchestrating computational tools such as volume and distance calculators with multi-agent collaboration and expert radiologist validation. We present SpatialMed, the first comprehensive benchmark for evaluating 3D spatial intelligence in medical MLLMs, comprising nearly 10K question-answer pairs across multiple organs and tumor types. Our evaluations on 14 state-of-the-art MLLMs and extensive analyses reveal that current models lack robust spatial reasoning capabilities for medical imaging.

Robust White Blood Cell Classification with Stain-Normalized Decoupled Learning and Ensembling

White blood cell (WBC) classification is fundamental for hematology applications such as infection assessment, leukemia screening, and treatment monitoring. However, real-world WBC datasets present substantial appearance variations caused by staining and scanning conditions, as well as severe class imbalance in which common cell types dominate while rare but clinically important categories are underrepresented. To address these challenges, we propose a stain-normalized, decoupled training framework that first learns transferable representations using instance-balanced sampling, and then rebalances the classifier with class-aware sampling and a hybrid loss combining effective-number weighting and focal modulation. In inference stage, we further enhance robustness by ensembling various trained backbones with test-time augmentation. Our approach achieved the top rank on the leaderboard of the WBCBench 2026: Robust White Blood Cell Classification Challenge at ISBI 2026.

Handling Supervision Scarcity in Chest X-ray Classification: Long-Tailed and Zero-Shot Learning

Chest X-ray (CXR) classification in clinical practice is often limited by imperfect supervision, arising from (i) extreme long-tailed multi-label disease distributions and (ii) missing annotations for rare or previously unseen findings. The CXR-LT 2026 challenge addresses these issues on a PadChest-based benchmark with a 36-class label space split into 30 in-distribution classes for training and 6 out-of-distribution (OOD) classes for zero-shot evaluation. We present task-specific solutions tailored to the distinct supervision regimes. For Task 1 (long-tailed multi-label classification), we adopt an imbalance-aware multi-label learning strategy to improve recognition of tail classes while maintaining stable performance on frequent findings. For Task 2 (zero-shot OOD recognition), we propose a prediction approach that produces scores for unseen disease categories without using any supervised labels or examples from the OOD classes during training. Evaluated with macro-averaged mean Average Precision (mAP), our method achieves strong performance on both tasks, ranking first on the public leaderboard of the development phase. Code and pre-trained models are available at https://github.com/hieuphamha19/CXR_LT.

Domain-invariant Mixed-domain Semi-supervised Medical Image Segmentation with Clustered Maximum Mean Discrepancy Alignment

Deep learning has shown remarkable progress in medical image semantic segmentation, yet its success heavily depends on large-scale expert annotations and consistent data distributions. In practice, annotations are scarce, and images are collected from multiple scanners or centers, leading to mixed-domain settings with unknown domain labels and severe domain gaps. Existing semi-supervised or domain adaptation approaches typically assume either a single domain shift or access to explicit domain indices, which rarely hold in real-world deployment. In this paper, we propose a domain-invariant mixed-domain semi-supervised segmentation framework that jointly enhances data diversity and mitigates domain bias. A Copy-Paste Mechanism (CPM) augments the training set by transferring informative regions across domains, while a Cluster Maximum Mean Discrepancy (CMMD) block clusters unlabeled features and aligns them with labeled anchors via an MMD objective, encouraging domain-invariant representations. Integrated within a teacher-student framework, our method achieves robust and precise segmentation even with very few labeled examples and multiple unknown domain discrepancies. Experiments on Fundus and M&Ms benchmarks demonstrate that our approach consistently surpasses semi-supervised and domain adaptation methods, establishing a potential solution for mixed-domain semi-supervised medical image segmentation.

CTest-Metric: A Unified Framework to Assess Clinical Validity of Metrics for CT Report Generation

In the generative AI era, where even critical medical tasks are increasingly automated, radiology report generation (RRG) continues to rely on suboptimal metrics for quality assessment. Developing domain-specific metrics has therefore been an active area of research, yet it remains challenging due to the lack of a unified, well-defined framework to assess their robustness and applicability in clinical contexts. To address this, we present CTest-Metric, a first unified metric assessment framework with three modules determining the clinical feasibility of metrics for CT RRG. The modules test: (i) Writing Style Generalizability (WSG) via LLM-based rephrasing; (ii) Synthetic Error Injection (SEI) at graded severities; and (iii) Metrics-vs-Expert correlation (MvE) using clinician ratings on 175 "disagreement" cases. Eight widely used metrics (BLEU, ROUGE, METEOR, BERTScore-F1, F1-RadGraph, RaTEScore, GREEN Score, CRG) are studied across seven LLMs built on a CT-CLIP encoder. Using our novel framework, we found that lexical NLG metrics are highly sensitive to stylistic variations; GREEN Score aligns best with expert judgments (Spearman~0.70), while CRG shows negative correlation; and BERTScore-F1 is least sensitive to factual error injection. We will release the framework, code, and allowable portion of the anonymized evaluation data (rephrased/error-injected CT reports), to facilitate reproducible benchmarking and future metric development.