Multi-Attention Stacked Ensemble for Lung Cancer Detection in CT Scans

In this work, we address the challenge of binary lung nodule classification (benign vs malignant) using CT images by proposing a multi-level attention stacked ensemble of deep neural networks. Three pretrained backbones - EfficientNet V2 S, MobileViT XXS, and DenseNet201 - are each adapted with a custom classification head tailored to 96 x 96 pixel inputs. A two-stage attention mechanism learns both model-wise and class-wise importance scores from concatenated logits, and a lightweight meta-learner refines the final prediction. To mitigate class imbalance and improve generalization, we employ dynamic focal loss with empirically calculated class weights, MixUp augmentation during training, and test-time augmentation at inference. Experiments on the LIDC-IDRI dataset demonstrate exceptional performance, achieving 98.09 accuracy and 0.9961 AUC, representing a 35 percent reduction in error rate compared to state-of-the-art methods. The model exhibits balanced performance across sensitivity (98.73) and specificity (98.96), with particularly strong results on challenging cases where radiologist disagreement was high. Statistical significance testing confirms the robustness of these improvements across multiple experimental runs. Our approach can serve as a robust, automated aid for radiologists in lung cancer screening.

Lung Nodule-SSM: Self-Supervised Lung Nodule Detection and Classification in Thoracic CT Images

Lung cancer remains among the deadliest types of cancer in recent decades, and early lung nodule detection is crucial for improving patient outcomes. The limited availability of annotated medical imaging data remains a bottleneck in developing accurate computer-aided diagnosis (CAD) systems. Self-supervised learning can help leverage large amounts of unlabeled data to develop more robust CAD systems. With the recent advent of transformer-based architecture and their ability to generalize to unseen tasks, there has been an effort within the healthcare community to adapt them to various medical downstream tasks. Thus, we propose a novel "LungNodule-SSM" method, which utilizes selfsupervised learning with DINOv2 as a backbone to enhance lung nodule detection and classification without annotated data. Our methodology has two stages: firstly, the DINOv2 model is pre-trained on unlabeled CT scans to learn robust feature representations, then secondly, these features are fine-tuned using transformer-based architectures for lesionlevel detection and accurate lung nodule diagnosis. The proposed method has been evaluated on the challenging LUNA 16 dataset, consisting of 888 CT scans, and compared with SOTA methods. Our experimental results show the superiority of our proposed method with an accuracy of 98.37%, explaining its effectiveness in lung nodule detection. The source code, datasets, and pre-processed data can be accessed using the link:https://github.com/EMeRALDsNRPU/Lung-Nodule-SSM-Self-Supervised-Lung-Nodule-Detection-and-Classification/tree/main

A Narrative Review on Large AI Models in Lung Cancer Screening, Diagnosis, and Treatment Planning

Lung cancer remains one of the most prevalent and fatal diseases worldwide, demanding accurate and timely diagnosis and treatment. Recent advancements in large AI models have significantly enhanced medical image understanding and clinical decision-making. This review systematically surveys the state-of-the-art in applying large AI models to lung cancer screening, diagnosis, prognosis, and treatment. We categorize existing models into modality-specific encoders, encoder-decoder frameworks, and joint encoder architectures, highlighting key examples such as CLIP, BLIP, Flamingo, BioViL-T, and GLoRIA. We further examine their performance in multimodal learning tasks using benchmark datasets like LIDC-IDRI, NLST, and MIMIC-CXR. Applications span pulmonary nodule detection, gene mutation prediction, multi-omics integration, and personalized treatment planning, with emerging evidence of clinical deployment and validation. Finally, we discuss current limitations in generalizability, interpretability, and regulatory compliance, proposing future directions for building scalable, explainable, and clinically integrated AI systems. Our review underscores the transformative potential of large AI models to personalize and optimize lung cancer care.

A Unified Multi-Scale Attention-Based Network for Automatic 3D Segmentation of Lung Parenchyma & Nodules In Thoracic CT Images

Lung cancer has been one of the major threats across the world with the highest mortalities. Computer-aided detection (CAD) can help in early detection and thus can help increase the survival rate. Accurate lung parenchyma segmentation (to include the juxta-pleural nodules) and lung nodule segmentation, the primary symptom of lung cancer, play a crucial role in the overall accuracy of the Lung CAD pipeline. Lung nodule segmentation is quite challenging because of the diverse nodule types and other inhibit structures present within the lung lobes. Traditional machine/deep learning methods suffer from generalization and robustness. Recent Vision Language Models/Foundation Models perform well on the anatomical level, but they suffer on fine-grained segmentation tasks, and their semi-automatic nature limits their effectiveness in real-time clinical scenarios. In this paper, we propose a novel method for accurate 3D segmentation of lung parenchyma and lung nodules. The proposed architecture is an attention-based network with residual blocks at each encoder-decoder state. Max pooling is replaced by strided convolutions at the encoder, and trilinear interpolation is replaced by transposed convolutions at the decoder to maximize the number of learnable parameters. Dilated convolutions at each encoder-decoder stage allow the model to capture the larger context without increasing computational costs. The proposed method has been evaluated extensively on one of the largest publicly available datasets, namely LUNA16, and is compared with recent notable work in the domain using standard performance metrics like Dice score, IOU, etc. It can be seen from the results that the proposed method achieves better performance than state-of-the-art methods. The source code, datasets, and pre-processed data can be accessed using the link: https://github.com/EMeRALDsNRPU/Attention-Based-3D-ResUNet.

MERA: Multimodal and Multiscale Self-Explanatory Model with Considerably Reduced Annotation for Lung Nodule Diagnosis

Lung cancer, a leading cause of cancer-related deaths globally, emphasises the importance of early detection for better patient outcomes. Pulmonary nodules, often early indicators of lung cancer, necessitate accurate, timely diagnosis. Despite Explainable Artificial Intelligence (XAI) advances, many existing systems struggle providing clear, comprehensive explanations, especially with limited labelled data. This study introduces MERA, a Multimodal and Multiscale self-Explanatory model designed for lung nodule diagnosis with considerably Reduced Annotation requirements. MERA integrates unsupervised and weakly supervised learning strategies (self-supervised learning techniques and Vision Transformer architecture for unsupervised feature extraction) and a hierarchical prediction mechanism leveraging sparse annotations via semi-supervised active learning in the learned latent space. MERA explains its decisions on multiple levels: model-level global explanations via semantic latent space clustering, instance-level case-based explanations showing similar instances, local visual explanations via attention maps, and concept explanations using critical nodule attributes. Evaluations on the public LIDC dataset show MERA's superior diagnostic accuracy and self-explainability. With only 1% annotated samples, MERA achieves diagnostic accuracy comparable to or exceeding state-of-the-art methods requiring full annotation. The model's inherent design delivers comprehensive, robust, multilevel explanations aligned closely with clinical practice, enhancing trustworthiness and transparency. Demonstrated viability of unsupervised and weakly supervised learning lowers the barrier to deploying diagnostic AI in broader medical domains. Our complete code is open-source available: https://github.com/diku-dk/credanno.

Vision-Language Model-Based Semantic-Guided Imaging Biomarker for Early Lung Cancer Detection

Objective: A number of machine learning models have utilized semantic features, deep features, or both to assess lung nodule malignancy. However, their reliance on manual annotation during inference, limited interpretability, and sensitivity to imaging variations hinder their application in real-world clinical settings. Thus, this research aims to integrate semantic features derived from radiologists' assessments of nodules, allowing the model to learn clinically relevant, robust, and explainable features for predicting lung cancer. Methods: We obtained 938 low-dose CT scans from the National Lung Screening Trial with 1,246 nodules and semantic features. The Lung Image Database Consortium dataset contains 1,018 CT scans, with 2,625 lesions annotated for nodule characteristics. Three external datasets were obtained from UCLA Health, the LUNGx Challenge, and the Duke Lung Cancer Screening. We finetuned a pretrained Contrastive Language-Image Pretraining model with a parameter-efficient fine-tuning approach to align imaging and semantic features and predict the one-year lung cancer diagnosis. Results: We evaluated the performance of the one-year diagnosis of lung cancer with AUROC and AUPRC and compared it to three state-of-the-art models. Our model demonstrated an AUROC of 0.90 and AUPRC of 0.78, outperforming baseline state-of-the-art models on external datasets. Using CLIP, we also obtained predictions on semantic features, such as nodule margin (AUROC: 0.81), nodule consistency (0.81), and pleural attachment (0.84), that can be used to explain model predictions. Conclusion: Our approach accurately classifies lung nodules as benign or malignant, providing explainable outputs, aiding clinicians in comprehending the underlying meaning of model predictions. This approach also prevents the model from learning shortcuts and generalizes across clinical settings.

Longitudinal Assessment of Lung Lesion Burden in CT

In the U.S., lung cancer is the second major cause of death. Early detection of suspicious lung nodules is crucial for patient treatment planning, management, and improving outcomes. Many approaches for lung nodule segmentation and volumetric analysis have been proposed, but few have looked at longitudinal changes in total lung tumor burden. In this work, we trained two 3D models (nnUNet) with and without anatomical priors to automatically segment lung lesions and quantified total lesion burden for each patient. The 3D model without priors significantly outperformed ($p < .001$) the model trained with anatomy priors. For detecting clinically significant lesions $>$ 1cm, a precision of 71.3\%, sensitivity of 68.4\%, and F1-score of 69.8\% was achieved. For segmentation, a Dice score of 77.1 $\pm$ 20.3 and Hausdorff distance error of 11.7 $\pm$ 24.1 mm was obtained. The median lesion burden was 6.4 cc (IQR: 2.1, 18.1) and the median volume difference between manual and automated measurements was 0.02 cc (IQR: -2.8, 1.2). Agreements were also evaluated with linear regression and Bland-Altman plots. The proposed approach can produce a personalized evaluation of the total tumor burden for a patient and facilitate interval change tracking over time.

CPLOYO: A Pulmonary Nodule Detection Model with Multi-Scale Feature Fusion and Nonlinear Feature Learning

The integration of Internet of Things (IoT) technology in pulmonary nodule detection significantly enhances the intelligence and real-time capabilities of the detection system. Currently, lung nodule detection primarily focuses on the identification of solid nodules, but different types of lung nodules correspond to various forms of lung cancer. Multi-type detection contributes to improving the overall lung cancer detection rate and enhancing the cure rate. To achieve high sensitivity in nodule detection, targeted improvements were made to the YOLOv8 model. Firstly, the C2f\_RepViTCAMF module was introduced to augment the C2f module in the backbone, thereby enhancing detection accuracy for small lung nodules and achieving a lightweight model design. Secondly, the MSCAF module was incorporated to reconstruct the feature fusion section of the model, improving detection accuracy for lung nodules of varying scales. Furthermore, the KAN network was integrated into the model. By leveraging the KAN network's powerful nonlinear feature learning capability, detection accuracy for small lung nodules was further improved, and the model's generalization ability was enhanced. Tests conducted on the LUNA16 dataset demonstrate that the improved model outperforms the original model as well as other mainstream models such as YOLOv9 and RT-DETR across various evaluation metrics.

An Efficient Approach to Detecting Lung Nodules Using Swin Transformer

Lung cancer has the highest rate of cancer-caused deaths, and early-stage diagnosis could increase the survival rate. Lung nodules are common indicators of lung cancer, making their detection crucial. Various lung nodule detection models exist, but many lack efficiency. Hence, we propose a more efficient approach by leveraging 2D CT slices, reducing computational load and complexity in training and inference. We employ the tiny version of Swin Transformer to benefit from Vision Transformers (ViT) while maintaining low computational cost. A Feature Pyramid Network is added to enhance detection, particularly for small nodules. Additionally, Transfer Learning is used to accelerate training. Our experimental results show that the proposed model outperforms state-of-the-art methods, achieving higher mAP and mAR for small nodules by 1.3% and 1.6%, respectively. Overall, our model achieves the highest mAP of 94.7% and mAR of 94.9%.

Hybrid CNN with Chebyshev Polynomial Expansion for Medical Image Analysis

Lung cancer remains one of the leading causes of cancer-related mortality worldwide, with early and accurate diagnosis playing a pivotal role in improving patient outcomes. Automated detection of pulmonary nodules in computed tomography (CT) scans is a challenging task due to variability in nodule size, shape, texture, and location. Traditional Convolutional Neural Networks (CNNs) have shown considerable promise in medical image analysis; however, their limited ability to capture fine-grained spatial-spectral variations restricts their performance in complex diagnostic scenarios. In this study, we propose a novel hybrid deep learning architecture that incorporates Chebyshev polynomial expansions into CNN layers to enhance expressive power and improve the representation of underlying anatomical structures. The proposed Chebyshev-CNN leverages the orthogonality and recursive properties of Chebyshev polynomials to extract high-frequency features and approximate complex nonlinear functions with greater fidelity. The model is trained and evaluated on benchmark lung cancer imaging datasets, including LUNA16 and LIDC-IDRI, achieving superior performance in classifying pulmonary nodules as benign or malignant. Quantitative results demonstrate significant improvements in accuracy, sensitivity, and specificity compared to traditional CNN-based approaches. This integration of polynomial-based spectral approximation within deep learning provides a robust framework for enhancing automated medical diagnostics and holds potential for broader applications in clinical decision support systems.