Vision-Language Models Encode Clinical Guidelines for Concept-Based Medical Reasoning

Concept Bottleneck Models (CBMs) are a prominent framework for interpretable AI that map learned visual features to a set of meaningful concepts for task-specific downstream predictions. Their sequential structure enhances transparency by connecting model predictions to the underlying concepts that support them. In medical imaging, where transparency is essential, CBMs offer an appealing foundation for explainable model design. However, discrete concept representations often overlook broader clinical context such as diagnostic guidelines and expert heuristics, reducing reliability in complex cases. We propose MedCBR, a concept-based reasoning framework that integrates clinical guidelines with vision-language and reasoning models. Labeled clinical descriptors are transformed into guideline-conformant text, and a concept-based model is trained with a multitask objective combining multimodal contrastive alignment, concept supervision, and diagnostic classification to jointly ground image features, concepts, and pathology. A reasoning model then converts these predictions into structured clinical narratives that explain the diagnosis, emulating expert reasoning based on established guidelines. MedCBR achieves superior diagnostic and concept-level performance, with AUROCs of 94.2% on ultrasound and 84.0% on mammography. Further experiments on non-medical datasets achieve 86.1% accuracy. Our framework enhances interpretability and forms an end-to-end bridge from medical image analysis to decision-making.

ProstNFound+: A Prospective Study using Medical Foundation Models for Prostate Cancer Detection

Purpose: Medical foundation models (FMs) offer a path to build high-performance diagnostic systems. However, their application to prostate cancer (PCa) detection from micro-ultrasound ({\mu}US) remains untested in clinical settings. We present ProstNFound+, an adaptation of FMs for PCa detection from {\mu}US, along with its first prospective validation. Methods: ProstNFound+ incorporates a medical FM, adapter tuning, and a custom prompt encoder that embeds PCa-specific clinical biomarkers. The model generates a cancer heatmap and a risk score for clinically significant PCa. Following training on multi-center retrospective data, the model is prospectively evaluated on data acquired five years later from a new clinical site. Model predictions are benchmarked against standard clinical scoring protocols (PRI-MUS and PI-RADS). Results: ProstNFound+ shows strong generalization to the prospective data, with no performance degradation compared to retrospective evaluation. It aligns closely with clinical scores and produces interpretable heatmaps consistent with biopsy-confirmed lesions. Conclusion: The results highlight its potential for clinical deployment, offering a scalable and interpretable alternative to expert-driven protocols.

Cinepro: Robust Training of Foundation Models for Cancer Detection in Prostate Ultrasound Cineloops

Prostate cancer (PCa) detection using deep learning (DL) models has shown potential for enhancing real-time guidance during biopsies. However, prostate ultrasound images lack pixel-level cancer annotations, introducing label noise. Current approaches often focus on limited regions of interest (ROIs), disregarding anatomical context necessary for accurate diagnosis. Foundation models can overcome this limitation by analyzing entire images to capture global spatial relationships; however, they still encounter challenges stemming from the weak labels associated with coarse pathology annotations in ultrasound data. We introduce Cinepro, a novel framework that strengthens foundation models' ability to localize PCa in ultrasound cineloops. Cinepro adapts robust training by integrating the proportion of cancer tissue reported by pathology in a biopsy core into its loss function to address label noise, providing a more nuanced supervision. Additionally, it leverages temporal data across multiple frames to apply robust augmentations, enhancing the model's ability to learn stable cancer-related features. Cinepro demonstrates superior performance on a multi-center prostate ultrasound dataset, achieving an AUROC of 77.1% and a balanced accuracy of 83.8%, surpassing current benchmarks. These findings underscore Cinepro's promise in advancing foundation models for weakly labeled ultrasound data.