医学 AI

Accurate survival prediction is essential for personalized treatment planning in head and neck cancer, yet remains challenging due to the heterogeneous and high-dimensional nature of multimodal clinical data. While deep survival models have improved predictive performance over classical statistical approaches, existing methods typically rely on static fusion strategies or temporally agnostic modeling, limiting their ability to capture structured clinical workflows. In this work, we propose ChronoSurv, a heterogeneous hierarchical directed graph framework for multimodal survival analysis. ChronoSurv represents patient care as a progression-aware clinical trajectory using directed graphs aligned with key diagnostic steps. A hierarchical topology incorporates fine-grained, coarse, and global representations, further supporting flexible adaptation to missing modalities, while heterogeneous message passing models complex and asymmetric relationships across modalities and clinical steps. Experimental results on two public datasets demonstrate that ChronoSurv achieves state-of-the-art discriminative performance while maintaining statistically reliable calibration. Comprehensive ablation studies further confirm the contribution of each architectural component, highlighting the potential of trajectory-aware graph modeling for multimodal survival prediction.

Mild Cognitive Impairment (MCI) is a medical condition characterized by a noticeable decline in memory, language, or thinking abilities. MCI detection from spontaneous speech is promising for scalable screening. However, learned models often exploit demographic cues correlated with labels, resulting in a large performance gap across subgroups. We present a multimodal framework that combines (i) cross-model fusion between modalities (speech, text, and image), and (ii) unlearning using gradient reversal that discourages the shared embedding from encoding task-irrelevant demographic attributes. Evaluated on the multilingual benchmarks TAUKADIAL and PREPARE, our method outperforms the state-of-the-art multilingual and multimodal baseline in MCI classification while substantially reducing the performance gap across patient subgroups (sex and language). We further analyze transfer across datasets, showing that demographic unlearning helps learn more robust representations for MCI detection.

Asthma causes expiratory airflow limitation and is clinically assessed using spirometry, which provides the FEV1/FVC ratio representing the proportion of air exhaled in the first second relative to total forced vital capacity. Prior studies suggest that respiratory sounds recorded at posterior sites (Left Lower, Left Upper, Right Upper, Right Lower) reflect regional airflow patterns. In this study, we investigate the relationship between the expiratory-to-inspiratory (E/I) spectral power ratio and FEV1/FVC in 141 participants aged 20-60 years using Spearman correlation across frequency subbands. The 100-200 Hz and 200-400 Hz bands showed significant correlations. Overall, lower posterior sites showed stronger associations; younger adults showed stronger correlations at the Left Lower site, whereas older adults showed stronger correlations at the Left Upper site. Gender-stratified analysis showed stronger Left Lower correlations in males and stronger Left Upper correlations in females.

Zero-shot anomaly detection (ZSAD) is attractive for medical imaging because clinical systems must handle heterogeneous acquisition protocols, changing patient populations, and pathologies for which annotated training data may be unavailable. Most existing zero-shot anomaly detection methods are designed for 2D images, and their direct extension to 3D medical volumes is limited by the scarcity of large-scale volumetric foundation models or by the difficulty of utilizing volumetric context. We propose CS3F, a training-free batch-based framework for ZSAD in 3D medical images using 2D foundation models. Each volume is decomposed along multiple anatomical axes and encoded slice-wise by a 2D vision transformer. These are then converted into localized volumetric tokens by pooling neighboring slice features. Anomaly scores are obtained from cross-subject mutual similarity: tokens that lack close analogues in other subjects are assigned higher anomaly scores. To reduce the attenuation of focal lesion signals caused by depth pooling, we introduce a coarse-to-fine tokenization strategy that enables fine-resolution volumetric scoring without exhaustive matching. CS3F is evaluated on brain MRI across metastases, glioma, and stroke, as well as validated on lung CT to test generalizability beyond atlas-aligned brain MRI. The results show that frozen 2D foundation models can support anomaly localization in 3D medical images, and that the benefit of fine tokenization depends strongly on lesion contrast and imaging modality.

Learning unsupervised representations of medical imaging cohorts can reveal clinically meaningful prototypes without expert labels, which are often noisy and fail to capture true pathological heterogeneity. However, existing deep latent-variable models estimate Gaussian mixture priors via Euclidean averaging, producing prototypes that drift off the curved data manifold and degenerate as the number of sub-populations grows. We propose a manifold-anchored variational framework built on a geometry-aware Expectation-Maximization (EM) algorithm, whose M-step selects each sub-population prototype as the graph medoid with the highest diffusion centrality on a heat-kernel-weighted latent graph, ensuring that every prototype remains on-manifold. A Dirichlet energy regularizer enforces geometric smoothness of the latent space, and a per-sub-population uncertainty score enables label-free quality assessment. \rev{The manifold-anchored EM is a general-purpose geometric tool that extends standard EM and applies readily to other latent-variable models beyond this setting.} On cardiac scar and brain MRI benchmarks, our framework attains the highest accuracy among all compared methods, produces the sharpest prototypes reported to date, and remains stable at large sub-population counts where all baselines degenerate.

Pathological images are inherently multi-scale, requiring pathologists to integrate evidence from global tissue architecture at low magnification to cellular morphology at higher magnification for accurate diagnosis. While existing pathological datasets for vision-language model (VLM) include various scales, they often lack an explicit cross-scale reasoning objective. This limitation prevents VLMs from capturing essential cross-scale representations and learning evidence-based reasoning. To bridge this gap, we introduce the first cross-scale training and evaluation paradigm that formulates pathology interpretation as multi-magnification reasoning. However, creating such a task reveals a critical challenge: multi-image visual question answering (VQA) is prone to text-only shortcuts, which allow models to guess answers using magnification-dependent artifacts rather than visual evidence. To address this, we propose a leakage-aware curation pipeline that combines adversarial text-only screening with constraint-guided question design. Using this pipeline, we construct Scale-VQA, a high-quality benchmark with 4,685 multiple-choice questions grounded in 2,537 pathology images across multiple magnification levels. Finally, we present ScaleReasoner-R1, a model trained via reinforcement learning to optimize performance on the cross-scale VQA task. ScaleReasoner-R1 achieves state-of-the-art performance on our cross-scale reasoning benchmark and generalizes to SOTA performance on established single-scale benchmarks. Findings suggest that even the limited cross-scale supervision can significantly improve pathological understanding. The code and demos will be open-sourced.

Clinician-centered evaluation is critical for validating medical AI systems, especially in ultrasound imaging where quantitative metrics do not always capture clinical usability. Existing medical image platforms primarily focus on dataset labeling. They lack integrated support for blinded model comparison and reproducible evaluation workflows. We present a clinician-centered pipeline for remote annotation and evaluation in ultrasound AI studies. The proposed pipeline uses a centralized server and lightweight browser interfaces to enable clinicians to perform annotation, blinded ranking, and review without local dataset downloads. The pipeline also supports multi-rater participation, centralized result aggregation, and automated statistical analysis. We validate the pipeline in a fetal ultrasound segmentation study with six raters spanning expert, generalist, and non-expert experience levels. The system automatically generated Spearman correlation, Kendall's $τ$, and top-1 selection statistics. Results indicated moderate to strong agreement across experts and other groups. The blinded evaluation results showed a tendency for later active learning models to be preferred. These outcomes suggest that the pipeline can support clinician-centered annotation and reproducible human-\ac{AI} evaluation studies in ultrasound imaging. The proposed pipeline is available on \href{https://github.com/13204942/SonoRate}{GitHub}.

Multimodal neuroimaging, integrating functional connectivity from fMRI and structural connectivity from DTI, enables non-invasive analysis of brain networks using graph neural networks. However, demographic factors such as age and sex systematically confound the relationship between brain connectivity and clinical outcomes, causing GNNs to exploit spurious shortcuts rather than learning causally invariant representations. While recent causal GNN methods introduce causality at the graph-modeling level, their causal mechanisms remain domain-agnostic without accounting for the real-world confounders inherent in clinical neuroimaging data. Moreover, brain networks are constructed from atlas-based parcellations where each region exhibits distinct sensitivity to demographic factors, necessitating region-aware adjustment. We propose Artemis, a region-level causal framework that bridges this gap with causal intervention at each brain region independently by learning region-specific confounder representations with lightweight parameters. Our adjustment comprehensively utilized the multimodal functional and structural features for graph reasoning as a plug-in module compatible with arbitrary GNN backbones. Experiments on three benchmarks, ADNI for disease diagnosis, OASIS for dementia staging, and HCP for sex classification, demonstrate consistent improvements over representative GNN-based baselines. Multiple supporting experiments further demonstrate statistical significance and neuroscientific interpretability.

Artificial intelligence has driven rapid progress in medical imaging research, producing increasingly sophisticated algorithms and steady improvements on benchmark tasks. However, this algorithm-centric trajectory has also revealed a growing imbalance: while computational methods advance rapidly, the conceptual foundations that define imaging tasks, evaluation metrics, and clinical meaning sometimes remain underexamined. In this Perspective, we distinguish algorithmic innovation, which focuses on improving computational implementations and performance within a fixed problem definition, from conceptual innovation, which reframes what problems are posed, how success is measured, and why an approach is clinically relevant. We argue that prevailing incentive structures, training pathways, and publication norms disproportionately reward algorithmic novelty, particularly for early-career researchers, while at times undervaluing conceptual contributions that are essential for scientific maturation and clinical translation. Through representative examples from medical imaging AI, we show how insufficient conceptual grounding can lead to misaligned objectives, fragile generalization, and limited real-world impact. We conclude with actionable recommendations for researchers, mentors, reviewers, and journals to better recognize, support, and integrate conceptual innovation alongside algorithmic advances.

Tissue motion correction through image registration is essential for ultrasound localization microscopy (ULM). Parametric image registration is commonly formulated as an optimization problem where motion parameters are iteratively updated to maximize image similarity, and used optimization algorithms typically rely on gradient information, the explicit evaluation of which can become computationally demanding. This work investigates Extremum Seeking Control (ESC) as an alternative to explicit derivative evaluation in image registration. By obtaining descent information via integrating perturbed and demodulated image similarity metric across iterations, ESC avoids differentiation of the image similarity metric with respect to motion parameters in each iteration. The classical ESC, whose optimization behavior approximates that of classical gradient descent (GD), is first compared with GD for affine image registration using simulated ground-truth motions derived from a beating ex vivo porcine heart dataset. The results show that ESC achieves registration accuracy and convergence behavior comparable to GD while reducing per-iteration computational cost by approximately 3.5-fold. ESC is subsequently employed in a two-stage motion correction pipeline, where affine registration compensates for global tissue motion and B-spline registration corrects residual local deformation. The proposed method is applied to ULM imaging of a beating ex vivo porcine heart and achieves a spatial resolution of 219 um, substantially below the half-wavelength diffraction limit of 321 um associated with 2.4 MHz diverging-wave imaging. These results demonstrate that ESC provides an effective alternative to explicit derivative evaluation in ULM image registration, enabling accurate motion correction and high-quality super-resolution imaging.

CT-derived airway models support pulmonary morphometry and airflow simulation, but are often limited by distal scan resolution and the need for substantial cleanup near bifurcations. Procedural alternatives are reproducible, yet many rely on stitched tubular primitives that introduce non-smooth junctions and poorly defined open boundaries. We present RespGeomLib, a reproducible parametric engine for generating analysis-ready human airway lumen surfaces from compact YAML specifications. The framework combines port-based assembly with implicit smooth-min junction blending to produce seamless junctions, while avoiding full-tree voxelization through analytic segments and local implicit extraction around bifurcations. Quantitatively, RespGeomLib yields cleaner junctions than a Boolean/stitch baseline and is substantially faster and more memory-efficient than whole-tree global implicit extraction. We further demonstrate morphometry-guided tree generation, controlled synthetic airway variants, and CFD-ready export with stable airflow simulation. RespGeomLib targets biomedical workflows requiring reproducible morphometry, controlled synthetic variants, and simulation-ready lumen geometry. The code is publicly available at https://nichula01.github.io/Respgeomlib/

Glucose forecasting algorithms are an important aspect of glycemic control management in type 1 diabetes. So far, the research community has developed numerous algorithms and models for forecasting. However, it is well-recognized that the lack of standardized model performance evaluation benchmarks makes fair comparison difficult and hinders further innovation, and thus benchmark standardization is in urgent need. Furthermore, many published glucose forecasting algorithms are limited to CGM data alone, ignoring other multimodal signals such as insulin dosing and carbohydrate intake. Here, we introduce MetaboNet-Bench, a benchmark for multimodal glucose forecasting for patients with type 1 diabetes that provides an extensible open-source evaluation framework for comparison of glucose forecasting algorithms that leverage glucose, insulin, and carbohydrate data. We then demonstrate its utility by benchmarking several recently published glucose forecasting models and a custom multimodal time-series model, representing different model architectures. The results show that the benefit of adding data modalities is conditioned on the complexity of the model and that incorporating more clinical metrics helps identify meaningful gaps to fill for future research.

Forces transmitted by bones are routinely studied in human biomechanics, but it is challenging to measure them non-invasively, especially outside of laboratory settings. We introduce a technique for non-invasive, in vivo measurement of tibial compressive force using flexural waves propagating in the tibia. Modelling the tibia as an axially compressed Euler-Bernoulli beam, we show that tibial flexural waves have load-dependent frequency spectra. Specifically, under physiological conditions, peak locations in the wave acceleration spectra vary linearly with the compressive force on the tibia and may be used as proxies for the compressive force. We test the validity of this technique using a proof-of-concept wearable system that generates flexural waves via a skin-mounted mechanical transducer and measures the spectra of these waves using a skin-mounted accelerometer. In agreement with beam theory, data from 9 participants demonstrate linear relationships between tibial compressive force and spectral peak location, with Pearson correlation coefficients $r=0.82 - 0.99$ (mean $r=0.93$) for medial-lateral swaying and $r=0.81 - 0.98$ (mean $r=0.93$) for walking trials. This flexural wave-based technique could give rise to a new class of wearable sensors for non-invasive physiological bone load monitoring and measurement, impacting research in human locomotion and sports medicine.

Psychophysical discrimination of structured light (SL) stimuli may be useful in screening for various macular disorders, including degenerative macular diseases. The circularly-oriented macular pigment optical density (coMPOD), calculated from the discrimination performance of SL-induced entoptic phenomena, may reveal a novel functional biomarker of macular health. In this study, we investigated the potential influence of eye dominance and testing order effects on SL-based stimulus perception, factors that potentially influence the sensitivity of screening tests based on SL technology. A total of 28 participants (aged 18-38 years) were selected for the study after undergoing a comprehensive eye examination. A psychophysical task was performed where various SL-based entoptic images with multiple azimuthal fringes rotating with a specific temporal frequency were projected onto the participants' retinas. By occluding the central areas of entoptic images, we measured the retinal eccentricity ($R$) of the perceivable area of the stimuli. The slope of the coMPOD profile ($a$-value) was calculated for each participant using a spatiotemporal sensitivity model that takes into account the perceptual threshold measurements of structured light stimuli with varying spatial densities and temporal frequencies. The Pearson correlation coefficient between eye dominance and testing order effects was $r=0.8$ ($p<0.01$). The Bland-Altman plots for both factors indicated zero bias. The results indicate repeatable measurements for both eyes, implying minimal impact from eye dominance and testing order on SL-based stimulus perception. The results provide a foundation for future studies exploring the clinical utility of SL tools in eye health.

Estimation of uplink channels is required for coherent over-the-air computation (OAC). When channel estimation is done using calibrated reciprocity, the estimates are only available locally to the devices. This poses a challenge for precoding and decoding, which cannot be coordinated centrally. To this end we use truncated channel inversion (TCI) and propose an approximate closed form solution and an exact numerical solver to optimize the TCI parameters. Importantly, we prove that the proposed TCI scheme is independent of the number of receiver antennas in terms of mean-square-error (MSE). Furthermore, our analysis reveals a clear connection between the MSE and expected aggregate phase error across devices which gives insight to the scalability of OAC. Finally, simulations with comparisons to reference methods from prior work with globally available error-free channel estimates show that proposed is close, even outperforming these references in MSE under some conditions.

Reference-based adaptive interference cancellation is evaluated for stereo audio recordings corrupted by real train noise and environmental background. The observed signal is modeled as a clean stereo program contaminated by an additive disturbance generated by an external acoustic source through unknown propagation paths. A second stereo recording, representing another filtered observation of the same physical noise source, is used as the reference input of a multi-reference recursive least-squares (RLS) estimator. The estimated train-interference component is subtracted from the noisy audio and followed by a finite-impulse-response low-pass postfilter. Three 74.01 s real audio sequences sampled at 11.025 kHz are processed under identical algorithmic parameters. Since clean ground truth is not available, performance is assessed with no-reference indicators: waveform behavior, Welch spectral estimates, RMS change, and residual normalized correlation with the reference. With 30 taps per reference channel, 15 anti-causal taps, and forgetting factor 0.999, the maximum reference correlation is reduced from 0.386--0.832 before processing to 0.011--0.016 after processing. The corresponding correlation-ratio reduction is approximately 30.6--34.1 dB, while the output RMS decreases by 1.8--4.8 dB depending on section and stereo channel. The results demonstrate that real train interference, including environmental acoustic effects, can be substantially attenuated when a correlated reference recording is available.

The development of medical AI is constrained by limited access to high-quality clinical data due to institutional silos and strict privacy regulations such as HIPAA and GDPR. Synthetic data generation offers a potential solution, but existing methods lack principled mechanisms to explicitly manage the privacy-utility trade-off, often degrading clinically meaningful patterns or risking patient re-identification. We present PSyGenTAB, a privacy-preserving generative framework that formulates synthetic healthcare data generation as a constrained optimization problem solved using the Augmented Lagrangian Method. By embedding configurable privacy constraints directly into model training, PSyGenTAB enforces minimum privacy thresholds while maximizing clinical data utility. Across multiple clinically motivated benchmarks, PSyGenTAB preserves inter-feature clinical relationships and minority-class diagnostic patterns essential for reliable health AI. Downstream evaluation using Train-on-Synthetic, Test-on-Real and Train-on-Real, Test-on-Synthetic protocols shows that models trained on synthetic data achieve performance comparable to those trained on real patient records. Privacy auditing further demonstrates reduced exact record reproduction and strong resilience to membership inference attacks. These results establish PSyGenTAB as a principled framework for balancing privacy protection and clinical utility in synthetic healthcare data, supporting secure cross-institutional AI development.