Foundation Models for Medical Imaging: Status, Challenges, and Directions

Foundation models (FMs) are rapidly reshaping medical imaging, shifting the field from narrowly trained, task-specific networks toward large, general-purpose models that can be adapted across modalities, anatomies, and clinical tasks. In this review, we synthesize the emerging landscape of medical imaging FMs along three major axes: principles of FM design, applications of FMs, and forward-looking challenges and opportunities. Taken together, this review provides a technically grounded, clinically aware, and future-facing roadmap for developing FMs that are not only powerful and versatile but also trustworthy and ready for responsible translation into clinical practice.

Physics Informed Generative AI Enabling Labour Free Segmentation For Microscopy Analysis

Semantic segmentation of microscopy images is a critical task for high-throughput materials characterisation, yet its automation is severely constrained by the prohibitive cost, subjectivity, and scarcity of expert-annotated data. While physics-based simulations offer a scalable alternative to manual labelling, models trained on such data historically fail to generalise due to a significant domain gap, lacking the complex textures, noise patterns, and imaging artefacts inherent to experimental data. This paper introduces a novel framework for labour-free segmentation that successfully bridges this simulation-to-reality gap. Our pipeline leverages phase-field simulations to generate an abundant source of microstructural morphologies with perfect, intrinsically-derived ground-truth masks. We then employ a Cycle-Consistent Generative Adversarial Network (CycleGAN) for unpaired image-to-image translation, transforming the clean simulations into a large-scale dataset of high-fidelity, realistic SEM images. A U-Net model, trained exclusively on this synthetic data, demonstrated remarkable generalisation when deployed on unseen experimental images, achieving a mean Boundary F1-Score of 0.90 and an Intersection over Union (IOU) of 0.88. Comprehensive validation using t-SNE feature-space projection and Shannon entropy analysis confirms that our synthetic images are statistically and featurally indistinguishable from the real data manifold. By completely decoupling model training from manual annotation, our generative framework transforms a data-scarce problem into one of data abundance, providing a robust and fully automated solution to accelerate materials discovery and analysis.

Motion Compensation for Multiple-Input-Multiple-Output Inverse Synthetic Aperture Imaging of Automotive Targets

Inverse synthetic aperture radar (ISAR) images generated from single-channel automotive radar data provide critical information about the shape and size of automotive targets. However, the quality of ISAR images degrades due to road clutter and when translational and higher order rotational motions of the targets are not suitably compensated. One method to enhance the signal-to-clutter-and-noise ratio (SCNR) of the systems is to leverage the advantages of the multiple-input-multiple-output (MIMO) framework available in commercial automotive radars to generate MIMO-ISAR images. While substantial research has been devoted to motion compensation of single-channel ISAR images, the effectiveness of these methods for MIMO-ISAR has not been studied extensively. This paper analyzes the performance of three popular motion compensation techniques - entropy minimization, cross-correlation, and phase gradient autofocus - on MIMO-ISAR. The algorithms are evaluated on the measurement data collected using Texas Instruments millimeter-wave MIMO radar. The results indicate that the cross-correlation MOCOMP performs better than the other two MOCOMP algorithms in the MIMO configuration, with an overall improvement of 36%.

FD-DB: Frequency-Decoupled Dual-Branch Network for Unpaired Synthetic-to-Real Domain Translation

Synthetic data provide low-cost, accurately annotated samples for geometry-sensitive vision tasks, but appearance and imaging differences between synthetic and real domains cause severe domain shift and degrade downstream performance. Unpaired synthetic-to-real translation can reduce this gap without paired supervision, yet existing methods often face a trade-off between photorealism and structural stability: unconstrained generation may introduce deformation or spurious textures, while overly rigid constraints limit adaptation to real-domain statistics. We propose FD-DB, a frequency-decoupled dual-branch model that separates appearance transfer into low-frequency interpretable editing and high-frequency residual compensation. The interpretable branch predicts physically meaningful editing parameters (white balance, exposure, contrast, saturation, blur, and grain) to build a stable low-frequency appearance base with strong content preservation. The free branch complements fine details through residual generation, and a gated fusion mechanism combines the two branches under explicit frequency constraints to limit low-frequency drift. We further adopt a two-stage training schedule that first stabilizes the editing branch and then releases the residual branch to improve optimization stability. Experiments on the YCB-V dataset show that FD-DB improves real-domain appearance consistency and significantly boosts downstream semantic segmentation performance while preserving geometric and semantic structures.

Imaging-Derived Coronary Fractional Flow Reserve: Advances in Physics-Based, Machine-Learning, and Physics-Informed Methods

Purpose of Review Imaging derived fractional flow reserve (FFR) is rapidly evolving beyond conventional computational fluid dynamics (CFD) based pipelines toward machine learning (ML), deep learning (DL), and physics informed approaches that enable fast, wire free, and scalable functional assessment of coronary stenosis. This review synthesizes recent advances in CT and angiography based FFR, with particular emphasis on emerging physics informed neural networks and neural operators (PINNs and PINOs) and key considerations for their clinical translation. Recent Findings ML/DL approaches have markedly improved automation and computational speed, enabling prediction of pressure and FFR from anatomical descriptors or angiographic contrast dynamics. However, their real-world performance and generalizability can remain variable and sensitive to domain shift, due to multi-center heterogeneity, interpretability challenges, and differences in acquisition protocols and image quality. Physics informed learning introduces conservation structure and boundary condition consistency into model training, improving generalizability and reducing dependence on dense supervision while maintaining rapid inference. Recent evaluation trends increasingly highlight deployment oriented metrics, including calibration, uncertainty quantification, and quality control gatekeeping, as essential for safe clinical use. Summary The field is converging toward imaging derived FFR methods that are faster, more automated, and more reliable. While ML/DL offers substantial efficiency gains, physics informed frameworks such as PINNs and PINOs may provide a more robust balance between speed and physical consistency. Prospective multi center validation and standardized evaluation will be critical to support broad and safe clinical adoption.

Where Do Images Come From? Analyzing Captions to Geographically Profile Datasets

Recent studies show that text-to-image models often fail to generate geographically representative images, raising concerns about the representativeness of their training data and motivating the question: which parts of the world do these training examples come from? We geographically profile large-scale multimodal datasets by mapping image-caption pairs to countries based on location information extracted from captions using LLMs. Studying English captions from three widely used datasets (Re-LAION, DataComp1B, and Conceptual Captions) across $20$ common entities (e.g., house, flag), we find that the United States, the United Kingdom, and Canada account for $48.0\%$ of samples, while South American and African countries are severely under-represented with only $1.8\%$ and $3.8\%$ of images, respectively. We observe a strong correlation between a country's GDP and its representation in the data ($ρ= 0.82$). Examining non-English subsets for $4$ languages from the Re-LAION dataset, we find that representation skews heavily toward countries where these languages are predominantly spoken. Additionally, we find that higher representation does not necessarily translate to greater visual or semantic diversity. Finally, analyzing country-specific images generated by Stable Diffusion v1.3 trained on Re-LAION, we show that while generations appear realistic, they are severely limited in their coverage compared to real-world images.

Geometric Image Editing via Effects-Sensitive In-Context Inpainting with Diffusion Transformers

Recent advances in diffusion models have significantly improved image editing. However, challenges persist in handling geometric transformations, such as translation, rotation, and scaling, particularly in complex scenes. Existing approaches suffer from two main limitations: (1) difficulty in achieving accurate geometric editing of object translation, rotation, and scaling; (2) inadequate modeling of intricate lighting and shadow effects, leading to unrealistic results. To address these issues, we propose GeoEdit, a framework that leverages in-context generation through a diffusion transformer module, which integrates geometric transformations for precise object edits. Moreover, we introduce Effects-Sensitive Attention, which enhances the modeling of intricate lighting and shadow effects for improved realism. To further support training, we construct RS-Objects, a large-scale geometric editing dataset containing over 120,000 high-quality image pairs, enabling the model to learn precise geometric editing while generating realistic lighting and shadows. Extensive experiments on public benchmarks demonstrate that GeoEdit consistently outperforms state-of-the-art methods in terms of visual quality, geometric accuracy, and realism.

Brazilian Portuguese Image Captioning with Transformers: A Study on Cross-Native-Translated Dataset

Image captioning (IC) refers to the automatic generation of natural language descriptions for images, with applications ranging from social media content generation to assisting individuals with visual impairments. While most research has been focused on English-based models, low-resource languages such as Brazilian Portuguese face significant challenges due to the lack of specialized datasets and models. Several studies create datasets by automatically translating existing ones to mitigate resource scarcity. This work addresses this gap by proposing a cross-native-translated evaluation of Transformer-based vision and language models for Brazilian Portuguese IC. We use a version of Flickr30K comprised of captions manually created by native Brazilian Portuguese speakers and compare it to a version with captions automatically translated from English to Portuguese. The experiments include a cross-context approach, where models trained on one dataset are tested on the other to assess the translation impact. Additionally, we incorporate attention maps for model inference interpretation and use the CLIP-Score metric to evaluate the image-description alignment. Our findings show that Swin-DistilBERTimbau consistently outperforms other models, demonstrating strong generalization across datasets. ViTucano, a Brazilian Portuguese pre-trained VLM, surpasses larger multilingual models (GPT-4o, LLaMa 3.2 Vision) in traditional text-based evaluation metrics, while GPT-4 models achieve the highest CLIP-Score, highlighting improved image-text alignment. Attention analysis reveals systematic biases, including gender misclassification, object enumeration errors, and spatial inconsistencies. The datasets and the models generated and analyzed during the current study are available in: https://github.com/laicsiifes/transformer-caption-ptbr.

SCAR: Satellite Imagery-Based Calibration for Aerial Recordings

We introduce SCAR, a method for long-term auto-calibration refinement of aerial visual-inertial systems that exploits georeferenced satellite imagery as a persistent global reference. SCAR estimates both intrinsic and extrinsic parameters by aligning aerial images with 2D--3D correspondences derived from publicly available orthophotos and elevation models. In contrast to existing approaches that rely on dedicated calibration maneuvers or manually surveyed ground control points, our method leverages external geospatial data to detect and correct calibration degradation under field deployment conditions. We evaluate our approach on six large-scale aerial campaigns conducted over two years under diverse seasonal and environmental conditions. Across all sequences, SCAR consistently outperforms established baselines (Kalibr, COLMAP, VINS-Mono), reducing median reprojection error by a large margin, and translating these calibration gains into substantially lower visual localization rotation errors and higher pose accuracy. These results demonstrate that SCAR provides accurate, robust, and reproducible calibration over long-term aerial operations without the need for manual intervention.

Controlled disagreement improves generalization in decentralized training

Decentralized training is often regarded as inferior to centralized training because the consensus errors between workers are thought to undermine convergence and generalization, even with homogeneous data distributions. This work challenges this view by introducing decentralized SGD with Adaptive Consensus (DSGD-AC), which intentionally preserves non-vanishing consensus errors through a time-dependent scaling mechanism. We prove that these errors are not random noise but systematically align with the dominant Hessian subspace, acting as structured perturbations that guide optimization toward flatter minima. Across image classification and machine translation benchmarks, DSGD-AC consistently surpasses both standard DSGD and centralized SGD in test accuracy and solution flatness. Together, these results establish consensus errors as a useful implicit regularizer and open a new perspective on the design of decentralized learning algorithms.