Astra: a generalizable report generation foundation model for 3D computed tomography

CT interpretation requires radiologists to review hundreds of volumetric slices per examination, making reporting time-consuming and highly expertise-dependent. Automated CT report generation offers a promising route to improving clinical efficiency, yet the field still lacks a generalizable CT report generation foundation model that supports multi-region reporting and remains robust across external real-world cohorts. Intrinsic inconsistencies in reporting style and diagnostic terminology across cohorts make naive joint training prone to noisy textual supervision, thereby limiting model generalizability. Here we present Astra, a generalizable CT report generation foundation model trained on 90,678 thoracoabdominal CT-report pairs (CTRgDB) with 353,671 abnormalities spanning eight organ systems. By harmonizing report style and further refining diagnostic consistency via reinforcement learning, Astra achieves style-consistent and diagnostically accurate report generation across diverse anatomical regions and institutions. Evaluating on CTRgDB and six external cohorts, Astra achieves state-of-the-art performance with a 44.1% average improvement in fine-grained diagnostic metrics (P<0.001). In real-world clinical workflows, Astra assistance accelerates chest report drafting by 29.6% and improves abdominal report completeness by 11.3% (P<0.001). Furthermore, Astra also demonstrates broad utility as a foundation for CT AI development, improving downstream diagnostic performance and scaling vision-language pretrain through high-quality report synthesis. Overall, Astra serves as a broadly accessible clinical assistant and a pivotal infrastructure for the next generation of AI-powered healthcare.

A physics-informed foundation model for quantitative diffusion MRI

Understanding the human brain requires access to its microscopic tissue architecture. Diffusion magnetic resonance imaging (MRI) provides the only noninvasive window into whole-brain microstructure in vivo, yet reliable quantitative mapping remains confined to specialized research settings requiring dense sampling and optimized acquisition protocols. To address this gap, we present a physics-informed generative microstructure network (PIGMENT) that learns a universal generative prior of human brain microstructure and adapts it zero-shot to each participant's measured data to recover subject-specific maps. Trained on 11375 scans spanning multiple sites, vendors, and field strengths, PIGMENT enabled reliable quantitative mapping for tensor, kurtosis, and NODDI models across external datasets from five independent centers. It remains effective where conventional fitting becomes unreliable, recovering meaningful maps from extremely sparse acquisitions while supporting downstream tractography and structural connectivity mapping. PIGMENT estimates demonstrated strong biological validity, preserving submillimeter cortical microarchitectural patterns and early-childhood white matter developmental trajectories from 10-fold accelerated scans. Furthermore, PIGMENT enables reliable quantitative tensor mapping on cost-efficient low-field systems and the extraction of tumor-related biomarkers using ultra-fast clinical protocols. Together, these results establish PIGMENT as a physics-informed foundation model that extends quantitative diffusion MRI into regimes traditionally too sparse, heterogeneous, or clinically constrained for reliable analysis.

MemCog: From Memory-as-Tool to Memory-as-Cognition in Conversational Agents

Existing agent memory systems universally follow what we term a Memory-as-Tool paradigm where a single query triggers one-shot retrieval of flat passage lists, suffering from passive invocation, reasoning-retrieval decoupling, and structural mismatch between retrieved fragments and the agent's navigational needs. We propose MemCog, a Memory-as-Cognition system that makes memory access an integral part of the reasoning process. MemCog organizes user knowledge as Navigable Memory Store with associative link graphs, exposes Cross-Dimensional Navigation Interface for multi-step reasoning-driven traversal, and employs Proactive Reasoning Protocol that drives agents to spontaneously initiate memory exploration from conversational context. We additionally construct ProactiveMemBench, the first benchmark for evaluating proactive memory triggering. Experiments show that MemCog achieves state-of-the-art on passive QA benchmarks (92.98 on LoCoMo, 95.8 on LongMemEval) while substantially outperforming baselines on ProactiveMemBench, demonstrating the advantage of Memory-as-Cognition.

Towards Reliable Fetal Ultrasound Interpretation with Multi-Agent Collaboration

Automated fetal ultrasound interpretation requires a workflow from visual perception, including plane recognition and anatomical segmentation, to clinical understanding, including biometric measurement and diagnostic reporting. However, the prevailing "one-task, one-model" paradigm limits systematic integration of evidence across this multi-step process. Although multimodal large language models (MLLMs) show promising visual understanding, their limited domain-specific grounding and hallucination risks restrict reliability in fetal ultrasound analysis. To address these limitations, we propose FetUSAgents, a tool-augmented multi-agent system for comprehensive fetal ultrasound interpretation, supporting visual question answering (VQA), report generation, image captioning, and video summarization. FetUSAgents coordinates task-specific visual tools through collaborative LLM agents and decomposes clinical queries into subtasks that progress from anatomical recognition to quantitative measurement. We further introduce Dual-Path Evidence Arbitration (DPEA), which integrates LLM-based deliberative reasoning with structured computational evidence from specialized visual tools. A retrieval-enhanced evidence bank consolidates intermediate findings to support traceable and clinically grounded conclusions. In addition, we construct FetUS-VQA, a dedicated VQA benchmark for fetal ultrasound, comprising 1,892 images and 3,205 question-answer pairs across 10 clinical tasks. Extensive out-of-distribution experiments show that FetUSAgents outperforms general and medical MLLMs, exceeding the strongest baseline by more than 25 percent in VQA accuracy. These results suggest a scalable route toward evidence-driven clinical assistants for prenatal imaging. Code is available.

INFANiTE: Implicit Neural representation for high-resolution Fetal brain spatio-temporal Atlas learNing from clinical Thick-slicE MRI

Spatio-temporal fetal brain atlases are important for characterizing normative neurodevelopment and identifying congenital anomalies. However, existing atlas construction pipelines necessitate days for slice-to-volume reconstruction (SVR) to generate high-resolution 3D brain volumes and several additional days for iterative volume registration, thereby rendering atlas construction from large-scale cohorts prohibitively impractical. We address these limitations with INFANiTE, an Implicit Neural Representation (INR) framework for high-resolution Fetal brain spatio-temporal Atlas learNing from clinical Thick-slicE MRI scans, bypassing both the costly SVR and the iterative non-rigid registration steps entirely, thereby substantially accelerating atlas construction. Extensive experiments demonstrate that INFANiTE outperforms existing baselines in subject consistency, reference fidelity, intrinsic quality and biological plausibility, even under challenging sparse-data settings. Additionally, INFANiTE reduces the end-to-end processing time (i.e., from raw scans to the final atlas) from days to hours compared to the traditional 3D volume-based pipeline (e.g., SyGN), facilitating large-scale population-level fetal brain analysis. Our code is publicly available at: https://anonymous.4open.science/r/INFANiTE-5D74

Any2Any 3D Diffusion Models with Knowledge Transfer: A Radiotherapy Planning Study

Voxel-wise dose prediction is a critical yet challenging task in practical radiotherapy (RT) planning, as bespoke models trained from scratch often struggle to generalize across diverse clinical settings. Meanwhile, generative models trained on billion-scale datasets from vision domains have achieved impressive performance. Herein, we propose DiffKT3D, a unified Any2Any 3D diffusion framework that leverages prior knowledge from pretrained video diffusion models for efficient and clinically meaningful dose prediction. To enable flexible conditioning across multiple clinical modalities (CT, anatomical structures, body, beam settings, etc.), we introduce an Any2Any conditional paradigm utilizing modality-specific embeddings without cross-attention overhead. Further, we design a novel reinforcement learning (RL) post-training mechanism guided by a clinically-informed Scorecard explicitly tailored to institutional treatment preferences. Compared with winner of GDP-HMM challenge, DiffKT3D sets a new state-of-the-art in dose prediction by reducing voxel-level MAE from 2.07 to 1.93. In addition, DiffKT3D achieves superior image quality and preference match. These results demonstrate that transferring diffusion priors via modality-aware conditioning and clinically aligned RL post-training can provide a robust and generalizable solution for RT planning across various clinical scenarios.

Annotation-free deep learning for detection and segmentation of fetal germinal matrix-intraventricular hemorrhage in brain MRI

Background: Prenatal germinal matrix-intraventricular hemorrhage (GMH-IVH) is a leading cause of infant mortality and neurodevelopmental impairment. Manual diagnosis and lesion segmentation are labor-intensive and error-prone. Deep learning models offer potential for automation but typically require large annotated datasets, which are challenging to obtain. Purpose: To develop and validate an annotation-free deep learning framework for automated detection and segmentation of GMH-IVH on brain MRI. Materials and Methods: This retrospective study analyzed 2D T2-weighted MRI data from pregnant women collected from October 2015 to October 2023 at one hospital (internal validation) and two hospitals (external validation). Eligible participants included healthy fetuses and those with GMH-IVH. FreeHemoSeg was developed and trained using pseudo GMH-IVH images synthesized from normal fetal data guided by medical priors. Primary outcomes included diagnostic accuracy (area under the ROC curve [AUROC], sensitivity, specificity) and segmentation accuracy (Dice similarity coefficient [DSC]). A reader study evaluated clinical utility. Results: A total of 1674 stacks from 558 pregnant women were analyzed. FreeHemoSeg achieved the highest performance in both internal (sensitivity: 0.914, 95% CI 0.869-0.945; specificity: 0.966, 95% CI 0.946-0.978; DSC: 0.559, 95% CI 0.546-0.571) and external validation (sensitivity: 0.824, 95% CI 0.739-0.885; specificity: 0.943, 95% CI 0.913-0.964; DSC: 0.512, 95% CI 0.497-0.526), outperforming supervised and unsupervised methods. FreeHemoSeg assistance improved radiologists' sensitivity (from 0.882 to 0.941-1.000) and diagnostic confidence while reducing interpretation time by 16.0-52.7%. Conclusion: FreeHemoSeg accurately detects and localizes fetal brain hemorrhages without annotated training data, enabling earlier diagnosis and supporting timely clinical management.

DPEPO: Diverse Parallel Exploration Policy Optimization for LLM-based Agents

Large language model (LLM) agents that follow the sequential "reason-then-act" paradigm have achieved superior performance in many complex tasks.However, these methods suffer from limited exploration and incomplete environmental understanding, as they interact with only a single environment per step. In this paper, we first introduce a novel paradigm that enables an agent to interact with multiple environments simultaneously and share cross-trajectory experiences. Building upon this paradigm, we further propose DPEPO, a reinforcement learning (RL) algorithm that encourages the agent to perform diverse parallel exploration. There are two stages in DPEPO: initial supervised fine-tuning (SFT) imparts basic parallel reasoning and action generation, followed by reinforcement learning stage with a hierarchical reward scheme. We design a parallel trajectory-level success reward and two step-level rewards: Diverse Action Reward and Diverse State Transition Reward, which actively penalize behavioral redundancy and promote broad exploration. Extensive experiments on ALFWorld and ScienceWorld show that DPEPO achieves state-of-the-art (SOTA) success rates, while maintaining comparable efficiency to strong sequential baselines. (Code is available at https://github.com/LePanda026/Code-for-DPEPO)

EXACT: an explainable anomaly-aware vision foundation model for analysis of 3D chest CT

Chest computed tomography (CT) is central to the detection and management of thoracic disease, yet the growing scale and complexity of volumetric imaging increasingly exceed what can be addressed by scan-level prediction alone. Clinically useful AI for CT must not only recognize disease across the whole volume, but also localize abnormalities and provide interpretable visual evidence. Existing vision-language foundation models typically compress scans and reports into global image-text representations, limiting their ability to preserve spatial evidence and support clinically meaningful interpretation. Here we developed EXACT, an explainable anomaly-aware foundation model for three-dimensional chest CT that learns spatially resolved representations from paired clinical scans and radiology reports. EXACT was pre-trained on 25,692 CT-reports pairs using anatomy-aware weak supervision, jointly learning organ segmentation and multi-instance anomaly localization without manual voxel-level annotations. The resulting organ-specific anomaly-aware maps assign each voxel a disease-specific anomaly score confined to its corresponding anatomy, jointly encoding lesion extent and organ-level context. In retrospective multinational and multi-center evaluations, EXACT showed broad and consistent improvements across clinically relevant CT tasks, spanning multi-disease diagnosis, zero-shot anomaly localization, downstream adaptation, and visually grounded report generation, outperforming existing three-dimensional medical foundation models. By transforming routine clinical CT scans and free-text reports into explainable voxel-level representations, EXACT establishes a scalable paradigm for trustworthy volumetric medical AI.

Understanding Secret Leakage Risks in Code LLMs: A Tokenization Perspective

Code secrets are sensitive assets for software developers, and their leakage poses significant cybersecurity risks. While the rapid development of AI code assistants powered by Code Large Language Models (CLLMs), CLLMs are shown to inadvertently leak such secrets due to a notorious memorization phenomenon. This study first reveals that Byte-Pair Encoding (BPE) tokenization leads to unexpected behavior of secret memorization, which we term as \textit{gibberish bias}. Specifically, we identified that some secrets are among the easiest for CLLMs to memorize. These secrets yield high character-level entropy, but low token-level entropy. Then, this paper supports the biased claim with numerical data. We identified that the roots of the bias are the token distribution shift between the CLLM training data and the secret data. We further discuss how gibberish bias manifests under the ``larger vocabulary'' trend. To conclude the paper, we discuss potential mitigation strategies and the broader implications on current tokenizer design.