Subgroup Performance of a Commercial Digital Breast Tomosynthesis Model for Breast Cancer Detection

While research has established the potential of AI models for mammography to improve breast cancer screening outcomes, there have not been any detailed subgroup evaluations performed to assess the strengths and weaknesses of commercial models for digital breast tomosynthesis (DBT) imaging. This study presents a granular evaluation of the Lunit INSIGHT DBT model on a large retrospective cohort of 163,449 screening mammography exams from the Emory Breast Imaging Dataset (EMBED). Model performance was evaluated in a binary context with various negative exam types (162,081 exams) compared against screen detected cancers (1,368 exams) as the positive class. The analysis was stratified across demographic, imaging, and pathologic subgroups to identify potential disparities. The model achieved an overall AUC of 0.91 (95% CI: 0.90-0.92) with a precision of 0.08 (95% CI: 0.08-0.08), and a recall of 0.73 (95% CI: 0.71-0.76). Performance was found to be robust across demographics, but cases with non-invasive cancers (AUC: 0.85, 95% CI: 0.83-0.87), calcifications (AUC: 0.80, 95% CI: 0.78-0.82), and dense breast tissue (AUC: 0.90, 95% CI: 0.88-0.91) were associated with significantly lower performance compared to other groups. These results highlight the need for detailed evaluation of model characteristics and vigilance in considering adoption of new tools for clinical deployment.

Efficient Parameter Adaptation for Multi-Modal Medical Image Segmentation and Prognosis

Cancer detection and prognosis relies heavily on medical imaging, particularly CT and PET scans. Deep Neural Networks (DNNs) have shown promise in tumor segmentation by fusing information from these modalities. However, a critical bottleneck exists: the dependency on CT-PET data concurrently for training and inference, posing a challenge due to the limited availability of PET scans. Hence, there is a clear need for a flexible and efficient framework that can be trained with the widely available CT scans and can be still adapted for PET scans when they become available. In this work, we propose a parameter-efficient multi-modal adaptation (PEMMA) framework for lightweight upgrading of a transformer-based segmentation model trained only on CT scans such that it can be efficiently adapted for use with PET scans when they become available. This framework is further extended to perform prognosis task maintaining the same efficient cross-modal fine-tuning approach. The proposed approach is tested with two well-known segementation backbones, namely UNETR and Swin UNETR. Our approach offers two main advantages. Firstly, we leverage the inherent modularity of the transformer architecture and perform low-rank adaptation (LoRA) as well as decomposed low-rank adaptation (DoRA) of the attention weights to achieve parameter-efficient adaptation. Secondly, by minimizing cross-modal entanglement, PEMMA allows updates using only one modality without causing catastrophic forgetting in the other. Our method achieves comparable performance to early fusion, but with only 8% of the trainable parameters, and demonstrates a significant +28% Dice score improvement on PET scans when trained with a single modality. Furthermore, in prognosis, our method improves the concordance index by +10% when adapting a CT-pretrained model to include PET scans, and by +23% when adapting for both PET and EHR data.

Predicting Surgical Safety Margins in Osteosarcoma Knee Resections: An Unsupervised Approach

According to the Pan American Health Organization, the number of cancer cases in Latin America was estimated at 4.2 million in 2022 and is projected to rise to 6.7 million by 2045. Osteosarcoma, one of the most common and deadly bone cancers affecting young people, is difficult to detect due to its unique texture and intensity. Surgical removal of osteosarcoma requires precise safety margins to ensure complete resection while preserving healthy tissue. Therefore, this study proposes a method for estimating the confidence interval of surgical safety margins in osteosarcoma surgery around the knee. The proposed approach uses MRI and X-ray data from open-source repositories, digital processing techniques, and unsupervised learning algorithms (such as k-means clustering) to define tumor boundaries. Experimental results highlight the potential for automated, patient-specific determination of safety margins.

Optimizing Neuro-Fuzzy and Colonial Competition Algorithms for Skin Cancer Diagnosis in Dermatoscopic Images

The rising incidence of skin cancer, coupled with limited public awareness and a shortfall in clinical expertise, underscores an urgent need for advanced diagnostic aids. Artificial Intelligence (AI) has emerged as a promising tool in this domain, particularly for distinguishing malignant from benign skin lesions. Leveraging publicly available datasets of skin lesions, researchers have been developing AI-based diagnostic solutions. However, the integration of such computer systems in clinical settings is still nascent. This study aims to bridge this gap by employing a fusion of image processing techniques and machine learning algorithms, specifically neuro-fuzzy and colonial competition approaches. Applied to dermoscopic images from the ISIC database, our method achieved a notable accuracy of 94% on a dataset of 560 images. These results underscore the potential of our approach in aiding clinicians in the early detection of melanoma, thereby contributing significantly to skin cancer diagnostics.

Anomaly Detection and Improvement of Clusters using Enhanced K-Means Algorithm

This paper introduces a unified approach to cluster refinement and anomaly detection in datasets. We propose a novel algorithm that iteratively reduces the intra-cluster variance of N clusters until a global minimum is reached, yielding tighter clusters than the standard k-means algorithm. We evaluate the method using intrinsic measures for unsupervised learning, including the silhouette coefficient, Calinski-Harabasz index, and Davies-Bouldin index, and extend it to anomaly detection by identifying points whose assignment causes a significant variance increase. External validation on synthetic data and the UCI Breast Cancer and UCI Wine Quality datasets employs the Jaccard similarity score, V-measure, and F1 score. Results show variance reductions of 18.7% and 88.1% on the synthetic and Wine Quality datasets, respectively, along with accuracy and F1 score improvements of 22.5% and 20.8% on the Wine Quality dataset.

FedSAF: A Federated Learning Framework for Enhanced Gastric Cancer Detection and Privacy Preservation

Gastric cancer is one of the most commonly diagnosed cancers and has a high mortality rate. Due to limited medical resources, developing machine learning models for gastric cancer recognition provides an efficient solution for medical institutions. However, such models typically require large sample sizes for training and testing, which can challenge patient privacy. Federated learning offers an effective alternative by enabling model training across multiple institutions without sharing sensitive patient data. This paper addresses the limited sample size of publicly available gastric cancer data with a modified data processing method. This paper introduces FedSAF, a novel federated learning algorithm designed to improve the performance of existing methods, particularly in non-independent and identically distributed (non-IID) data scenarios. FedSAF incorporates attention-based message passing and the Fisher Information Matrix to enhance model accuracy, while a model splitting function reduces computation and transmission costs. Hyperparameter tuning and ablation studies demonstrate the effectiveness of this new algorithm, showing improvements in test accuracy on gastric cancer datasets, with FedSAF outperforming existing federated learning methods like FedAMP, FedAvg, and FedProx. The framework's robustness and generalization ability were further validated across additional datasets (SEED, BOT, FashionMNIST, and CIFAR-10), achieving high performance in diverse environments.

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.

OpenPros: A Large-Scale Dataset for Limited View Prostate Ultrasound Computed Tomography

Prostate cancer is one of the most common and lethal cancers among men, making its early detection critically important. Although ultrasound imaging offers greater accessibility and cost-effectiveness compared to MRI, traditional transrectal ultrasound methods suffer from low sensitivity, especially in detecting anteriorly located tumors. Ultrasound computed tomography provides quantitative tissue characterization, but its clinical implementation faces significant challenges, particularly under anatomically constrained limited-angle acquisition conditions specific to prostate imaging. To address these unmet needs, we introduce OpenPros, the first large-scale benchmark dataset explicitly developed for limited-view prostate USCT. Our dataset includes over 280,000 paired samples of realistic 2D speed-of-sound (SOS) phantoms and corresponding ultrasound full-waveform data, generated from anatomically accurate 3D digital prostate models derived from real clinical MRI/CT scans and ex vivo ultrasound measurements, annotated by medical experts. Simulations are conducted under clinically realistic configurations using advanced finite-difference time-domain and Runge-Kutta acoustic wave solvers, both provided as open-source components. Through comprehensive baseline experiments, we demonstrate that state-of-the-art deep learning methods surpass traditional physics-based approaches in both inference efficiency and reconstruction accuracy. Nevertheless, current deep learning models still fall short of delivering clinically acceptable high-resolution images with sufficient accuracy. By publicly releasing OpenPros, we aim to encourage the development of advanced machine learning algorithms capable of bridging this performance gap and producing clinically usable, high-resolution, and highly accurate prostate ultrasound images. The dataset is publicly accessible at https://open-pros.github.io/.

Generalizing imaging biomarker repeatability studies using Bayesian inference: Applications in detecting heterogeneous treatment response in whole-body diffusion-weighted MRI of metastatic prostate cancer

The assessment of imaging biomarkers is critical for advancing precision medicine and improving disease characterization. Despite the availability of methods to derive disease heterogeneity metrics in imaging studies, a robust framework for evaluating measurement uncertainty remains underdeveloped. To address this gap, we propose a novel Bayesian framework to assess the precision of disease heterogeneity measures in biomarker studies. Our approach extends traditional methods for evaluating biomarker precision by providing greater flexibility in statistical assumptions and enabling the analysis of biomarkers beyond univariate or multivariate normally-distributed variables. Using Hamiltonian Monte Carlo sampling, the framework supports both, for example, normally-distributed and Dirichlet-Multinomial distributed variables, enabling the derivation of posterior distributions for biomarker parameters under diverse model assumptions. Designed to be broadly applicable across various imaging modalities and biomarker types, the framework builds a foundation for generalizing reproducible and objective biomarker evaluation. To demonstrate utility, we apply the framework to whole-body diffusion-weighted MRI (WBDWI) to assess heterogeneous therapeutic responses in metastatic bone disease. Specifically, we analyze data from two patient studies investigating treatments for metastatic castrate-resistant prostate cancer (mCRPC). Our results reveal an approximately 70% response rate among individual tumors across both studies, objectively characterizing differential responses to systemic therapies and validating the clinical relevance of the proposed methodology. This Bayesian framework provides a powerful tool for advancing biomarker research across diverse imaging-based studies while offering valuable insights into specific clinical applications, such as mCRPC treatment response.

Towards order of magnitude X-ray dose reduction in breast cancer imaging using phase contrast and deep denoising

Breast cancer is the most frequently diagnosed human cancer in the United States at present. Early detection is crucial for its successful treatment. X-ray mammography and digital breast tomosynthesis are currently the main methods for breast cancer screening. However, both have known limitations in terms of their sensitivity and specificity to breast cancers, while also frequently causing patient discomfort due to the requirement for breast compression. Breast computed tomography is a promising alternative, however, to obtain high-quality images, the X-ray dose needs to be sufficiently high. As the breast is highly radiosensitive, dose reduction is particularly important. Phase-contrast computed tomography (PCT) has been shown to produce higher-quality images at lower doses and has no need for breast compression. It is demonstrated in the present study that, when imaging full fresh mastectomy samples with PCT, deep learning-based image denoising can further reduce the radiation dose by a factor of 16 or more, without any loss of image quality. The image quality has been assessed both in terms of objective metrics, such as spatial resolution and contrast-to-noise ratio, as well as in an observer study by experienced medical imaging specialists and radiologists. This work was carried out in preparation for live patient PCT breast cancer imaging, initially at specialized synchrotron facilities.