Principled Confidence Estimation for Deep Computed Tomography

We present a principled framework for confidence estimation in computed tomography (CT) reconstruction. Based on the sequential likelihood mixing framework (Kirschner et al., 2025), we establish confidence regions with theoretical coverage guarantees for deep-learning-based CT reconstructions. We consider a realistic forward model following the Beer-Lambert law, i.e., a log-linear forward model with Poisson noise, closely reflecting clinical and scientific imaging conditions. The framework is general and applies to both classical algorithms and deep learning reconstruction methods, including U-Nets, U-Net ensembles, and generative Diffusion models. Empirically, we demonstrate that deep reconstruction methods yield substantially tighter confidence regions than classical reconstructions, without sacrificing theoretical coverage guarantees. Our approach allows the detection of hallucinations in reconstructed images and provides interpretable visualizations of confidence regions. This establishes deep models not only as powerful estimators, but also as reliable tools for uncertainty-aware medical imaging.

LEAD: Layer-wise Expert-aligned Decoding for Faithful Radiology Report Generation

Radiology Report Generation (RRG) aims to produce accurate and coherent diagnostics from medical images. Although large vision language models (LVLM) improve report fluency and accuracy, they exhibit hallucinations, generating plausible yet image-ungrounded pathological details. Existing methods primarily rely on external knowledge guidance to facilitate the alignment between generated text and visual information. However, these approaches often ignore the inherent decoding priors and vision-language alignment biases in pretrained models and lack robustness due to reliance on constructed guidance. In this paper, we propose Layer-wise Expert-aligned Decoding (LEAD), a novel method to inherently modify the LVLM decoding trajectory. A multiple experts module is designed for extracting distinct pathological features which are integrated into each decoder layer via a gating mechanism. This layer-wise architecture enables the LLM to consult expert features at every inference step via a learned gating function, thereby dynamically rectifying decoding biases and steering the generation toward factual consistency. Experiments conducted on multiple public datasets demonstrate that the LEAD method yields effective improvements in clinical accuracy metrics and mitigates hallucinations while preserving high generation quality.

Towards Segmenting the Invisible: An End-to-End Registration and Segmentation Framework for Weakly Supervised Tumour Analysis

Liver tumour ablation presents a significant clinical challenge: whilst tumours are clearly visible on pre-operative MRI, they are often effectively invisible on intra-operative CT due to minimal contrast between pathological and healthy tissue. This work investigates the feasibility of cross-modality weak supervision for scenarios where pathology is visible in one modality (MRI) but absent in another (CT). We present a hybrid registration-segmentation framework that combines MSCGUNet for inter-modal image registration with a UNet-based segmentation module, enabling registration-assisted pseudo-label generation for CT images. Our evaluation on the CHAOS dataset demonstrates that the pipeline can successfully register and segment healthy liver anatomy, achieving a Dice score of 0.72. However, when applied to clinical data containing tumours, performance degrades substantially (Dice score of 0.16), revealing the fundamental limitations of current registration methods when the target pathology lacks corresponding visual features in the target modality. We analyse the "domain gap" and "feature absence" problems, demonstrating that whilst spatial propagation of labels via registration is feasible for visible structures, segmenting truly invisible pathology remains an open challenge. Our findings highlight that registration-based label transfer cannot compensate for the absence of discriminative features in the target modality, providing important insights for future research in cross-modality medical image analysis. Code an weights are available at: https://github.com/BudhaTronix/Weakly-Supervised-Tumour-Detection

Visual concept ranking uncovers medical shortcuts used by large multimodal models

Ensuring the reliability of machine learning models in safety-critical domains such as healthcare requires auditing methods that can uncover model shortcomings. We introduce a method for identifying important visual concepts within large multimodal models (LMMs) and use it to investigate the behaviors these models exhibit when prompted with medical tasks. We primarily focus on the task of classifying malignant skin lesions from clinical dermatology images, with supplemental experiments including both chest radiographs and natural images. After showing how LMMs display unexpected gaps in performance between different demographic subgroups when prompted with demonstrating examples, we apply our method, Visual Concept Ranking (VCR), to these models and prompts. VCR generates hypotheses related to different visual feature dependencies, which we are then able to validate with manual interventions.

ECG-R1: Protocol-Guided and Modality-Agnostic MLLM for Reliable ECG Interpretation

Electrocardiography (ECG) serves as an indispensable diagnostic tool in clinical practice, yet existing multimodal large language models (MLLMs) remain unreliable for ECG interpretation, often producing plausible but clinically incorrect analyses. To address this, we propose ECG-R1, the first reasoning MLLM designed for reliable ECG interpretation via three innovations. First, we construct the interpretation corpus using \textit{Protocol-Guided Instruction Data Generation}, grounding interpretation in measurable ECG features and monograph-defined quantitative thresholds and diagnostic logic. Second, we present a modality-decoupled architecture with \textit{Interleaved Modality Dropout} to improve robustness and cross-modal consistency when either the ECG signal or ECG image is missing. Third, we present \textit{Reinforcement Learning with ECG Diagnostic Evidence Rewards} to strengthen evidence-grounded ECG interpretation. Additionally, we systematically evaluate the ECG interpretation capabilities of proprietary, open-source, and medical MLLMs, and provide the first quantitative evidence that severe hallucinations are widespread, suggesting that the public should not directly trust these outputs without independent verification. Code and data are publicly available at \href{https://github.com/PKUDigitalHealth/ECG-R1}{here}, and an online platform can be accessed at \href{http://ai.heartvoice.com.cn/ECG-R1/}{here}.

A3-TTA: Adaptive Anchor Alignment Test-Time Adaptation for Image Segmentation

Test-Time Adaptation (TTA) offers a practical solution for deploying image segmentation models under domain shift without accessing source data or retraining. Among existing TTA strategies, pseudo-label-based methods have shown promising performance. However, they often rely on perturbation-ensemble heuristics (e.g., dropout sampling, test-time augmentation, Gaussian noise), which lack distributional grounding and yield unstable training signals. This can trigger error accumulation and catastrophic forgetting during adaptation. To address this, we propose \textbf{A3-TTA}, a TTA framework that constructs reliable pseudo-labels through anchor-guided supervision. Specifically, we identify well-predicted target domain images using a class compact density metric, under the assumption that confident predictions imply distributional proximity to the source domain. These anchors serve as stable references to guide pseudo-label generation, which is further regularized via semantic consistency and boundary-aware entropy minimization. Additionally, we introduce a self-adaptive exponential moving average strategy to mitigate label noise and stabilize model update during adaptation. Evaluated on both multi-domain medical images (heart structure and prostate segmentation) and natural images, A3-TTA significantly improves average Dice scores by 10.40 to 17.68 percentage points compared to the source model, outperforming several state-of-the-art TTA methods under different segmentation model architectures. A3-TTA also excels in continual TTA, maintaining high performance across sequential target domains with strong anti-forgetting ability. The code will be made publicly available at https://github.com/HiLab-git/A3-TTA.

SRA-Seg: Synthetic to Real Alignment for Semi-Supervised Medical Image Segmentation

Synthetic data, an appealing alternative to extensive expert-annotated data for medical image segmentation, consistently fails to improve segmentation performance despite its visual realism. The reason being that synthetic and real medical images exist in different semantic feature spaces, creating a domain gap that current semi-supervised learning methods cannot bridge. We propose SRA-Seg, a framework explicitly designed to align synthetic and real feature distributions for medical image segmentation. SRA-Seg introduces a similarity-alignment (SA) loss using frozen DINOv2 embeddings to pull synthetic representations toward their nearest real counterparts in semantic space. We employ soft edge blending to create smooth anatomical transitions and continuous labels, eliminating the hard boundaries from traditional copy-paste augmentation. The framework generates pseudo-labels for synthetic images via an EMA teacher model and applies soft-segmentation losses that respect uncertainty in mixed regions. Our experiments demonstrate strong results: using only 10% labeled real data and 90% synthetic unlabeled data, SRA-Seg achieves 89.34% Dice on ACDC and 84.42% on FIVES, significantly outperforming existing semi-supervised methods and matching the performance of methods using real unlabeled data.

MedSAM-Agent: Empowering Interactive Medical Image Segmentation with Multi-turn Agentic Reinforcement Learning

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available \href{https://github.com/CUHK-AIM-Group/MedSAM-Agent}{here}.

Bayesian Integration of Nonlinear Incomplete Clinical Data

Multimodal clinical data are characterized by high dimensionality, heterogeneous representations, and structured missingness, posing significant challenges for predictive modeling, data integration, and interpretability. We propose BIONIC (Bayesian Integration of Nonlinear Incomplete Clinical data), a unified probabilistic framework that integrates heterogeneous multimodal data under missingness through a joint generative-discriminative latent architecture. BIONIC uses pretrained embeddings for complex modalities such as medical images and clinical text, while incorporating structured clinical variables directly within a Bayesian multimodal formulation. The proposed framework enables robust learning in partially observed and semi-supervised settings by explicitly modeling modality-level and variable-level missingness, as well as missing labels. We evaluate BIONIC on three multimodal clinical and biomedical datasets, demonstrating strong and consistent discriminative performance compared to representative multimodal baselines, particularly under incomplete data scenarios. Beyond predictive accuracy, BIONIC provides intrinsic interpretability through its latent structure, enabling population-level analysis of modality relevance and supporting clinically meaningful insight.

Scale-Cascaded Diffusion Models for Super-Resolution in Medical Imaging

Diffusion models have been increasingly used as strong generative priors for solving inverse problems such as super-resolution in medical imaging. However, these approaches typically utilize a diffusion prior trained at a single scale, ignoring the hierarchical scale structure of image data. In this work, we propose to decompose images into Laplacian pyramid scales and train separate diffusion priors for each frequency band. We then develop an algorithm to perform super-resolution that utilizes these priors to progressively refine reconstructions across different scales. Evaluated on brain, knee, and prostate MRI data, our approach both improves perceptual quality over baselines and reduces inference time through smaller coarse-scale networks. Our framework unifies multiscale reconstruction and diffusion priors for medical image super-resolution.