OPERA: Offline Policy-guided Expert Routing and Adaptation for Universal Biomedical Image Analysis

Biomedical image analysis spans diverse modalities and tasks, yet real-world deployment is hindered by severe distribution shifts across scanners, protocols, and patient populations. High-performing models consequently require repeated domain-specific fine-tuning, which is a costly cycle that becomes impractical when labels are scarce or privacy constraints limit data sharing. We propose OPERA (Offline Policy-guided Expert Routing and Adaptation), a multi-agent ensemble framework that addresses this deployment bottleneck by treating expert weight assignment as an offline policy learning problem: a routing policy is learned from a small validation set without gradient updates to any expert agent, then deployed with test-time adaptation to handle distribution shift. OPERA coordinates heterogeneous specialist agents through complementary mechanisms. The expert profiling module learns selection policies offline, enabling informed allocation of expertise. Each agent undergoes confidence calibration through temperature adjustment, ensuring more reliable probabilistic outputs. OPERA also incorporates distribution aware adaptation, where class weights are dynamically adjusted at the batch level using statistics derived from unlabeled test data. Instance level routing assigns each sample to the most suitable expert by leveraging inter model agreement and predictive entropy. We evaluate OPERA on 9 datasets covering fundus photography, chest X-ray, CT, MRI, and multimodal diagnostic benchmarks, comparing against 30+ baselines across classification, segmentation, and multimodal settings. OPERA consistently improves performance and calibration quality, demonstrating that offline policy-guided expert agents coordination is a practical path to deployable biomedical AI without retraining. Code is on \href{https://github.com/HUANGLIZI/OPERA}{GitHub}.

A Smooth Phase-Separation Model for Weak-Boundary Segmentation of Homogeneous Structures

Segmentation of adjacent structures with similar intensity distributions remains a challenging problem in image analysis, particularly when object boundaries are weak or ambiguous. Under such conditions, classical variational models may suffer from degenerated image-driven forces, leading to boundary leakage or undesired merging of neighboring regions. To address these limitations, we propose a smooth phase-separation variational model based on the Cahn--Hilliard equation for weak-boundary segmentation of homogeneous-appearance structures. The proposed framework integrates softmax-based region fitting with Cahn--Hilliard phase-field regularization to maintain interface discrimination under weak image-driven forces. We further introduce a mixed $L^2-H^{-1}$ gradient flow, which preserves higher-order interfacial regularization while allowing adaptive changes of phase masses, establish the continuous energy dissipation law, and prove the existence and uniqueness of weak solutions in the natural solution class. For numerical computation, we develop a stabilized scalar auxiliary variable (SAV) scheme that is linear, FFT-based, and satisfies a modified discrete energy dissipation law. Numerical experiments on synthetic and medical images demonstrate that the proposed method effectively separates adjacent homogeneous structures across weak boundaries and achieves competitive segmentation accuracy and improved boundary localization compared with representative variational, phase-field, and deep learning methods.

Larch: Learned Query Optimization for Semantic Predicates

With the advent of Large Language Models (LLMs), many database systems introduced semantic operators that enabled analytical queries over unstructured data (e.g. text, images, videos). Semantic operators typically incur high inference costs and latencies making semantic (AI) SQL queries challenging to apply on large scale datasets. At the same time, their semantic nature leads database engines to treat them as black boxes, making AISQL queries difficult to optimize. In this paper, we introduce Larch, a framework for optimizing the execution of semantic filters in AI SQL queries. Larch was inspired by two key observations: i) the high latency of semantic operators leaves significant room for computationally-heavy runtime optimization techniques, ii) unstructured data are typically accompanied by semantic information in the form of embeddings allowing for efficient semantic comparisons between AI_FILTER prompts and data values. Based on these two key observations, we present two Larch variants: Larch-A2C and Larch-Sel. Larch-A2C encodes arbitrary semantic filters expression tree using an embedding-augmented Gated Graph Neural Network and formulates the filter evaluation order as a Markov decision process. In contrast, Larch-Sel leverages a supervised learning model to predict filter selectivities, subsequently applying dynamic programming to find a near-optimal evaluation order for each input row. Evaluated across diverse real-world datasets and comprehensive synthetic workloads, both Larch variants always outperform existing semantic filter optimization techniques in terms of token usage. Our results demonstrate that Larch is robust across diverse workloads, reducing total token cost overhead by 3x-19x compared to Palimpzest and Quest.

MapAgent: An Industrial-Grade Agentic Framework for City-scale Lane-level Map Generation

Lane-level maps are critical infrastructure for autonomous driving and lane-level navigation, yet constructing and maintaining standardized lane networks for hundreds of cities remains highly labor-intensive. Recent end-to-end vectorized mapping methods can predict lane geometry and topology directly from sensor data, but they typically treat mapping specifications and traffic regulations as implicit, dataset-dependent supervision. Moreover, in complex scenes (e.g., worn or missing markings and occlusions), correct lane configurations are often under-determined by visual evidence alone, making specification violations a major source of human post-editing. We propose MapAgent, an industrial-grade agentic architecture that augments a vectorization backbone for specification-compliant lane-map production. Rather than merely adding an agent loop to map prediction, MapAgent couples backbone perception with explicit specification verification, constraint-aware reasoning, and deterministic map editing under a bounded, verification-driven Judge-Planner-Worker loop. A vision-language Judge diagnoses errors by jointly inspecting visual evidence and draft vectors, while a tool-calling Planner generates minimal corrective edits with post-edit re-validation. To remain scalable for city-scale production, MapAgent is selectively triggered only on tiles with low backbone confidence, adding modest overhead while preserving throughput. Experiments on real-world datasets show consistent gains over strong production baselines, especially in complex and long-tail scenarios. Additionally, MapAgent has been integrated into Baidu Maps, supporting lane-level map generation for over 360 cities nationwide and elevating the overall production automation to over 95%, demonstrating MapAgent's practicality and effectiveness for large-scale lane-level map generation.

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.