A Second-Order Attention Mechanism For Prostate Cancer Segmentation and Detection in Bi-Parametric MRI

The detection of clinically significant prostate cancer lesions (csPCa) from biparametric magnetic resonance imaging (bp-MRI) has emerged as a noninvasive imaging technique for improving accurate diagnosis. Nevertheless, the analysis of such images remains highly dependent on the subjective expert interpretation. Deep learning approaches have been proposed for csPCa lesions detection and segmentation, but they remain limited due to their reliance on extensively annotated datasets. Moreover, the high lesion variability across prostate zones poses additional challenges, even for expert radiologists. This work introduces a second-order geometric attention (SOGA) mechanism that guides a dedicated segmentation network, through skip connections, to detect csPCa lesions. The proposed attention is modeled on the Riemannian manifold, learning from symmetric positive definitive (SPD) representations. The proposed mechanism was integrated into standard U-Net and nnU-Net backbones, and was validated on the publicly available PI-CAI dataset, achieving an Average Precision (AP) of 0.37 and an Area Under the ROC Curve (AUC-ROC) of 0.83, outperforming baseline networks and attention-based methods. Furthermore, the approach was evaluated on the Prostate158 dataset as an independent test cohort, achieving an AP of 0.37 and an AUC-ROC of 0.75, confirming robust generalization and suggesting discriminative learned representations.

nnMIL: A generalizable multiple instance learning framework for computational pathology

Computational pathology holds substantial promise for improving diagnosis and guiding treatment decisions. Recent pathology foundation models enable the extraction of rich patch-level representations from large-scale whole-slide images (WSIs), but current approaches for aggregating these features into slide-level predictions remain constrained by design limitations that hinder generalizability and reliability. Here, we developed nnMIL, a simple yet broadly applicable multiple-instance learning framework that connects patch-level foundation models to robust slide-level clinical inference. nnMIL introduces random sampling at both the patch and feature levels, enabling large-batch optimization, task-aware sampling strategies, and efficient and scalable training across datasets and model architectures. A lightweight aggregator performs sliding-window inference to generate ensemble slide-level predictions and supports principled uncertainty estimation. Across 40,000 WSIs encompassing 35 clinical tasks and four pathology foundation models, nnMIL consistently outperformed existing MIL methods for disease diagnosis, histologic subtyping, molecular biomarker detection, and pan- cancer prognosis prediction. It further demonstrated strong cross-model generalization, reliable uncertainty quantification, and robust survival stratification in multiple external cohorts. In conclusion, nnMIL offers a practical and generalizable solution for translating pathology foundation models into clinically meaningful predictions, advancing the development and deployment of reliable AI systems in real-world settings.

Adapted Foundation Models for Breast MRI Triaging in Contrast-Enhanced and Non-Contrast Enhanced Protocols

Background: Magnetic resonance imaging (MRI) has high sensitivity for breast cancer detection, but interpretation is time-consuming. Artificial intelligence may aid in pre-screening. Purpose: To evaluate the DINOv2-based Medical Slice Transformer (MST) for ruling out significant findings (Breast Imaging Reporting and Data System [BI-RADS] >=4) in contrast-enhanced and non-contrast-enhanced abbreviated breast MRI. Materials and Methods: This institutional review board approved retrospective study included 1,847 single-breast MRI examinations (377 BI-RADS >=4) from an in-house dataset and 924 from an external validation dataset (Duke). Four abbreviated protocols were tested: T1-weighted early subtraction (T1sub), diffusion-weighted imaging with b=1500 s/mm2 (DWI1500), DWI1500+T2-weighted (T2w), and T1sub+T2w. Performance was assessed at 90%, 95%, and 97.5% sensitivity using five-fold cross-validation and area under the receiver operating characteristic curve (AUC) analysis. AUC differences were compared with the DeLong test. False negatives were characterized, and attention maps of true positives were rated in the external dataset. Results: A total of 1,448 female patients (mean age, 49 +/- 12 years) were included. T1sub+T2w achieved an AUC of 0.77 +/- 0.04; DWI1500+T2w, 0.74 +/- 0.04 (p=0.15). At 97.5% sensitivity, T1sub+T2w had the highest specificity (19% +/- 7%), followed by DWI1500+T2w (17% +/- 11%). Missed lesions had a mean diameter <10 mm at 95% and 97.5% thresholds for both T1sub and DWI1500, predominantly non-mass enhancements. External validation yielded an AUC of 0.77, with 88% of attention maps rated good or moderate. Conclusion: At 97.5% sensitivity, the MST framework correctly triaged cases without BI-RADS >=4, achieving 19% specificity for contrast-enhanced and 17% for non-contrast-enhanced MRI. Further research is warranted before clinical implementation.

Multimodal RGB-HSI Feature Fusion with Patient-Aware Incremental Heuristic Meta-Learning for Oral Lesion Classification

Early detection of oral cancer and potentially malignant disorders is challenging in low-resource settings due to limited annotated data. We present a unified four-class oral lesion classifier that integrates deep RGB embeddings, hyperspectral reconstruction, handcrafted spectral-textural descriptors, and demographic metadata. A pathologist-verified subset of oral cavity images was curated and processed using a fine-tuned ConvNeXt-v2 encoder, followed by RGB-to-HSI reconstruction into 31-band hyperspectral cubes. Haemoglobin-sensitive indices, texture features, and spectral-shape measures were extracted and fused with deep and clinical features. Multiple machine-learning models were assessed with patient-wise validation. We further introduce an incremental heuristic meta-learner (IHML) that combines calibrated base classifiers through probabilistic stacking and patient-level posterior smoothing. On an unseen patient split, the proposed framework achieved a macro F1 of 66.23% and an accuracy of 64.56%. Results demonstrate that hyperspectral reconstruction and uncertainty-aware meta-learning substantially improve robustness for real-world oral lesion screening.

Dynamic Weight Adjustment for Knowledge Distillation: Leveraging Vision Transformer for High-Accuracy Lung Cancer Detection and Real-Time Deployment

This paper presents the FuzzyDistillViT-MobileNet model, a novel approach for lung cancer (LC) classification, leveraging dynamic fuzzy logic-driven knowledge distillation (KD) to address uncertainty and complexity in disease diagnosis. Unlike traditional models that rely on static KD with fixed weights, our method dynamically adjusts the distillation weight using fuzzy logic, enabling the student model to focus on high-confidence regions while reducing attention to ambiguous areas. This dynamic adjustment improves the model ability to handle varying uncertainty levels across different regions of LC images. We employ the Vision Transformer (ViT-B32) as the instructor model, which effectively transfers knowledge to the student model, MobileNet, enhancing the student generalization capabilities. The training process is further optimized using a dynamic wait adjustment mechanism that adapts the training procedure for improved convergence and performance. To enhance image quality, we introduce pixel-level image fusion improvement techniques such as Gamma correction and Histogram Equalization. The processed images (Pix1 and Pix2) are fused using a wavelet-based fusion method to improve image resolution and feature preservation. This fusion method uses the wavedec2 function to standardize images to a 224x224 resolution, decompose them into multi-scale frequency components, and recursively average coefficients at each level for better feature representation. To address computational efficiency, Genetic Algorithm (GA) is used to select the most suitable pre-trained student model from a pool of 12 candidates, balancing model performance with computational cost. The model is evaluated on two datasets, including LC25000 histopathological images (99.16% accuracy) and IQOTH/NCCD CT-scan images (99.54% accuracy), demonstrating robustness across different imaging domains.

A Density-Informed Multimodal Artificial Intelligence Framework for Improving Breast Cancer Detection Across All Breast Densities

Mammography, the current standard for breast cancer screening, has reduced sensitivity in women with dense breast tissue, contributing to missed or delayed diagnoses. Thermalytix, an AI-based thermal imaging modality, captures functional vascular and metabolic cues that may complement mammographic structural data. This study investigates whether a breast density-informed multi-modal AI framework can improve cancer detection by dynamically selecting the appropriate imaging modality based on breast tissue composition. A total of 324 women underwent both mammography and thermal imaging. Mammography images were analyzed using a multi-view deep learning model, while Thermalytix assessed thermal images through vascular and thermal radiomics. The proposed framework utilized Mammography AI for fatty breasts and Thermalytix AI for dense breasts, optimizing predictions based on tissue type. This multi-modal AI framework achieved a sensitivity of 94.55% (95% CI: 88.54-100) and specificity of 79.93% (95% CI: 75.14-84.71), outperforming standalone mammography AI (sensitivity 81.82%, specificity 86.25%) and Thermalytix AI (sensitivity 92.73%, specificity 75.46%). Importantly, the sensitivity of Mammography dropped significantly in dense breasts (67.86%) versus fatty breasts (96.30%), whereas Thermalytix AI maintained high and consistent sensitivity in both (92.59% and 92.86%, respectively). This demonstrates that a density-informed multi-modal AI framework can overcome key limitations of unimodal screening and deliver high performance across diverse breast compositions. The proposed framework is interpretable, low-cost, and easily deployable, offering a practical path to improving breast cancer screening outcomes in both high-resource and resource-limited settings.

Dark-Field X-Ray Imaging Significantly Improves Deep-Learning based Detection of Synthetic Early-Stage Lung Tumors in Preclinical Models

Low-dose computed tomography (LDCT) is the current standard for lung cancer screening, yet its adoption and accessibility remain limited. Many regions lack LDCT infrastructure, and even among those screened, early-stage cancer detection often yield false positives, as shown in the National Lung Screening Trial (NLST) with a sensitivity of 93.8 percent and a false-positive rate of 26.6 percent. We aim to investigate whether X-ray dark-field imaging (DFI) radiograph, a technique sensitive to small-angle scatter from alveolar microstructure and less susceptible to organ shadowing, can significantly improve early-stage lung tumor detection when coupled with deep-learning segmentation. Using paired attenuation (ATTN) and DFI radiograph images of euthanized mouse lungs, we generated realistic synthetic tumors with irregular boundaries and intensity profiles consistent with physical lung contrast. A U-Net segmentation network was trained on small patches using either ATTN, DFI, or a combination of ATTN and DFI channels. Results show that the DFI-only model achieved a true-positive detection rate of 83.7 percent, compared with 51 percent for ATTN-only, while maintaining comparable specificity (90.5 versus 92.9 percent). The combined ATTN and DFI input achieved 79.6 percent sensitivity and 97.6 percent specificity. In conclusion, DFI substantially improves early-tumor detectability in comparison to standard attenuation radiography and shows potential as an accessible, low-cost, low-dose alternative for pre-clinical or limited-resource screening where LDCT is unavailable.

MV-MLM: Bridging Multi-View Mammography and Language for Breast Cancer Diagnosis and Risk Prediction

Large annotated datasets are essential for training robust Computer-Aided Diagnosis (CAD) models for breast cancer detection or risk prediction. However, acquiring such datasets with fine-detailed annotation is both costly and time-consuming. Vision-Language Models (VLMs), such as CLIP, which are pre-trained on large image-text pairs, offer a promising solution by enhancing robustness and data efficiency in medical imaging tasks. This paper introduces a novel Multi-View Mammography and Language Model for breast cancer classification and risk prediction, trained on a dataset of paired mammogram images and synthetic radiology reports. Our MV-MLM leverages multi-view supervision to learn rich representations from extensive radiology data by employing cross-modal self-supervision across image-text pairs. This includes multiple views and the corresponding pseudo-radiology reports. We propose a novel joint visual-textual learning strategy to enhance generalization and accuracy performance over different data types and tasks to distinguish breast tissues or cancer characteristics(calcification, mass) and utilize these patterns to understand mammography images and predict cancer risk. We evaluated our method on both private and publicly available datasets, demonstrating that the proposed model achieves state-of-the-art performance in three classification tasks: (1) malignancy classification, (2) subtype classification, and (3) image-based cancer risk prediction. Furthermore, the model exhibits strong data efficiency, outperforming existing fully supervised or VLM baselines while trained on synthetic text reports and without the need for actual radiology reports.

MedFedPure: A Medical Federated Framework with MAE-based Detection and Diffusion Purification for Inference-Time Attacks

Artificial intelligence (AI) has shown great potential in medical imaging, particularly for brain tumor detection using Magnetic Resonance Imaging (MRI). However, the models remain vulnerable at inference time when they are trained collaboratively through Federated Learning (FL), an approach adopted to protect patient privacy. Adversarial attacks can subtly alter medical scans in ways invisible to the human eye yet powerful enough to mislead AI models, potentially causing serious misdiagnoses. Existing defenses often assume centralized data and struggle to cope with the decentralized and diverse nature of federated medical settings. In this work, we present MedFedPure, a personalized federated learning defense framework designed to protect diagnostic AI models at inference time without compromising privacy or accuracy. MedFedPure combines three key elements: (1) a personalized FL model that adapts to the unique data distribution of each institution; (2) a Masked Autoencoder (MAE) that detects suspicious inputs by exposing hidden perturbations; and (3) an adaptive diffusion-based purification module that selectively cleans only the flagged scans before classification. Together, these steps offer robust protection while preserving the integrity of normal, benign images. We evaluated MedFedPure on the Br35H brain MRI dataset. The results show a significant gain in adversarial robustness, improving performance from 49.50% to 87.33% under strong attacks, while maintaining a high clean accuracy of 97.67%. By operating locally and in real time during diagnosis, our framework provides a practical path to deploying secure, trustworthy, and privacy-preserving AI tools in clinical workflows. Index Terms: cancer, tumor detection, federated learning, masked autoencoder, diffusion, privacy

General OOD Detection via Model-aware and Subspace-aware Variable Priority

Out-of-distribution (OOD) detection is essential for determining when a supervised model encounters inputs that differ meaningfully from its training distribution. While widely studied in classification, OOD detection for regression and survival analysis remains limited due to the absence of discrete labels and the challenge of quantifying predictive uncertainty. We introduce a framework for OOD detection that is simultaneously model aware and subspace aware, and that embeds variable prioritization directly into the detection step. The method uses the fitted predictor to construct localized neighborhoods around each test case that emphasize the features driving the model's learned relationship and downweight directions that are less relevant to prediction. It produces OOD scores without relying on global distance metrics or estimating the full feature density. The framework is applicable across outcome types, and in our implementation we use random forests, where the rule structure yields transparent neighborhoods and effective scoring. Experiments on synthetic and real data benchmarks designed to isolate functional shifts show consistent improvements over existing methods. We further demonstrate the approach in an esophageal cancer survival study, where distribution shifts related to lymphadenectomy identify patterns relevant to surgical guidelines.