Medical Physics

Head and neck radiation oncology, with its complex locality and epidemiology, requires various imaging techniques to achieve sufficient visualization. Through collaboration with medical physicists, radiation therapists, radiation oncologists, and neuroradiologists, our group clinically implemented a standard set of magnetic resonance imaging (MRI) sequences on an MR-simulation scanner for three anatomical regions: skull base, oral cavity, and larynx/pharynx. A total of 41 patients with head and neck cancer and 3 volunteers were scanned on either a 1.5T or 3T MR-simulation scanner. Sequences described include Dixon-based approaches, SPAIR-based approaches, short T2-based approaches, and quantitative imaging methods. We describe and outline the steps to optimize these notable MRI sequences to aid in successful implementation in a radiation oncology clinic.

Background: Patient-specific dosimetry in targeted radionuclide therapy (TRT) is increasingly supported by quantitative imaging; however, voxel-scale dose estimates cannot resolve cellular and subcellular heterogeneity present within tumor tissue. Conventional cellular dosimetry models often represent cells as regularly packed spheres, which may not capture realistic tumor microarchitecture. This study investigated how histopathology-informed three-dimensional (3D) tumor microarchitecture influences cellular absorbed-dose distributions, predicted radiobiological response, and treatment-related conclusions in TRT. Methods: Realistic 3D cellular tumor models were constructed from thick-section 3D cyclic immunofluorescence (3D CyCIF) imaging data. Monte Carlo radiation-transport simulations were performed for Lu-177, Pd-103, Tb-161 and Y-90, with activity localized in cancer-cell subcellular compartments and in non-cancer targets. Absorbed dose per total cluster decay was calculated individually for each cell nucleus and compared with corresponding simplified spherical tumor models. Cell survival fractions were estimated using the linear-quadratic model, and tumor control probability (TCP) was calculated from the individual cancer-cell survival probabilities. Results: Simplified model overestimated mean cancer-cell nuclear absorbed dose by 9.54% to 14.51% for nuclear localization and by 33.23% to 44.88% for cytoplasmic and membrane localization. In larger tissue models, simplified and realistic geometries produced comparable mean absorbed doses in several cases; however, the realistic models consistently generated broader cellular dose distributions, including low-dose cancer-cell subpopulations not captured by the simplified models. These dose-distribution differences propagated into wider survival-fraction distributions and altered TCP predictions. In the spatially heterogeneous tumor region, the realistic model required 1.11- to 1.33-fold higher activity to reach TCP90 for nuclear localization, and 1.49- to 5.93-fold higher activity for cytoplasmic and membrane localization. For similar tumor control, the radionuclide and source-localization combination associated with the greatest preservation of surrounding non-cancer cells differed between the simplified and realistic models. The intra-voxel analysis further showed that homogeneous voxel-scale activity assumptions can obscure biologically relevant microscopic dose heterogeneity. Conclusion: Native 3D tumor microarchitecture substantially influences cellular absorbed-dose distributions, predicted biological response, and treatment-related conclusions. Histopathology-informed 3D cellular models can be used as a complementary framework for characterizing cellular dose heterogeneity and may improve the evaluation of radionuclides and subcellular targeting strategies in heterogeneous tumor tissue.

Deep-silicon photon-counting CT uses a detector architecture distinct from cadmium-telluride systems and has not been evaluated for pediatric head imaging. To compare attenuation-dependent performance of deep-silicon photon-counting CT (dSi-PCCT) with energy-integrating detector CT (EID-CT) and assess spectral and ultra-high-resolution (UHR) reconstructions from one acquisition. Graded-thickness cranial attenuator and pediatric head phantoms were scanned at a matched target volume CT dose index of 18 mGy. dSi-PCCT used 120 kVp and generated 50-, 65-, and 100-keV images; EID-CT used 80 and 100 kVp. We measured CT-number bias, noise, contrast, and contrast-to-noise ratio (CNR) across 0--9 mm of nominal skull thickness. Mixed-effects models assessed imaging-condition effects. We compared matched standard-resolution and UHR temporal-bone images and generated calcium- and water-density maps from the same dSi-PCCT scan. Noise increased by 4.54%, 3.07%, and 1.35% per millimeter at 50, 65, and 100 keV, respectively, versus 8.38% and 7.84% at 80 and 100 kVp. Corresponding CNR decreases were 4.17%, 3.25%, and 1.75% versus 8.94% and 8.54% (interaction {rho} < 0.001). Changes in absolute CT-number bias and contrast did not differ among conditions ({rho} = 0.92 and {rho} = 0.59). In the pediatric head phantom, model-estimated 50-keV CNR ratios were 1.299 (95% CI, 1.163--1.452) versus 80 kVp and 1.424 (95% CI, 1.275--1.592) versus 100 kVp. Across three temporal-bone edges, UHR transition widths were 58.6%-61.9% narrower than standard-resolution widths. dSi-PCCT maintained CNR more consistently as nominal skull thickness increased and provided complementary spectral and UHR pediatric head images from one acquisition.

To compare virtual noncontrast (VNC) error between deep-silicon photon-counting CT (PCCT) and dual-energy energy-integrating detector CT (EID-CT) in a matched phantom and characterize tissue-specific error in humans. This prospective exploratory study included a matched phantom experiment and pilot human evaluation. Prototype projection-domain water-density maps served as the VNC surrogate. Twenty-four vials containing 0.1--20 mg I/mL in deionized water or simulated blood were scanned with PCCT and EID-CT. Three men underwent true noncontrast and contrast-enhanced PCCT; 80 matched measurements were analyzed. Paired t tests and mixed-effects models assessed system differences and iodine associations. Three participants (mean age, 67 {+/-} 10 years; all men) were included. Mean VNC error was 29.1 HU lower with PCCT than EID-CT (95% CI, 15.5--42.7 HU; {rho} < 0.001). Error was not associated with iodine concentration for PCCT (slope, 0.03 HU per mg I/mL; 95% CI, -0.92 to 0.98; {rho} = 0.95) but increased for EID-CT (slope, 3.51 HU per mg I/mL; 95% CI, 2.56--4.46 HU; {rho} < 0.001). The slopes differed by 3.48 HU per mg I/mL ({rho} < 0.001). In humans, errors in five non-blood-pool tissues were within 5 HU. Error was not associated with iodine concentration among 61 non-blood-pool measurements (adjusted slope, -0.17 HU per mg I/mL; 95% CI, -1.22 to 0.88; {rho} = 0.75). PCCT provided VNC measurements with errors closer to zero and less dependent on iodine than EID-CT in the phantom. In humans, error was generally small in non-blood-pool tissues and was not associated with iodine concentration.

To evaluate whether eight-bin deep-silicon photon-counting CT can quantify iodine and gadolinium separately and distinguish radiopaque embolic beads from vascular contrast in tumor phantoms. In this phantom study, two-input decomposition of scanner-generated iodine and water images was compared with three- and five-material decomposition of five reconstructed energy-bin images in 56 common test vials, including nine simulated-blood preparations. One tantalum and one bismuth vial were also tested with five-material decomposition. A separately calibrated two-input method using scanner-generated 70-keV and iodine images was applied to four static 3D-printed tumor vascular models: iodine-only and gadolinium-only controls and two models with iodine-containing beads and gadolinium-filled channels. Concentration errors were summarized by bias and root mean square error (RMSE). For iodine, RMSE was 0.40, 0.73, and 1.12 mg I/mL with two-input, three-material, and five-material decomposition, respectively; corresponding gadolinium RMSEs were 0.57, 0.55, and 0.46 mg Gd/mL. Two-input biases were +0.01 mg I/mL and +0.29 mg Gd/mL. Five-material decomposition distinguished tantalum and bismuth in the separate test vials. Beads and vascular gadolinium were spatially separated in the tumor models. In the two bead-containing models, gadolinium measured 32.56 {+/-} 8.02 and 37.02 {+/-} 7.93 mg Gd/mL (mean {+/-} spatial SD), compared with the prepared 35.00 mg Gd/mL. Deep-silicon photon-counting CT separately visualized radiopaque embolic beads and quantified vascular gadolinium from a single acquisition. Recalibrated scanner-generated images supported quantitative dual-contrast imaging, while research energy-bin decomposition distinguished additional materials.

Purpose: To evaluate whether visually assessed high-quality prostate MRI, as defined by the Prostate Imaging Quality (PI-QUAL) scoring system, is sufficient to ensure consistent AI model performance, or whether hidden acquisition-related technical effects introduce variability that cannot be detected through visual inspection. Methods: This retrospective study included 568 bpMRI scans from seven institutions, classified using PI-QUAL v2 into high-quality (scores 2-3) and low-quality (score 1) groups. Quantitative image quality features were extracted using MRQy from T2w and ADC sequences. Three experiments were conducted on high-quality scans: (1) unsupervised clustering to identify hidden technical batch effects; (2) V-Net models (M) for prostate capsule segmentation on T2w using single-cluster and balanced multi-cluster training strategies; and (3) VoxelMorph-based deformable registration (M2) to align ADC maps to T2w images. Performance metrics included DSC, precision, recall, volume ratio, HD95, ASSD, and TRE. Kruskal-Wallis tests assessed cross-cluster variability, Two One-Sided Tests (TOST) evaluated performance equivalence, and bootstrap resampling quantified training efficiency. Results: Clustering identified four clusters among 277 high-quality bpMRI scans. Single-cluster models showed variable performance (DSC=0.41-0.85) with significant batch effects (p<0.001), even with 140 training samples. The balanced multi-cluster model (n=60) eliminated batch effects (p=0.075), achieved equivalent performance (p<0.001), and demonstrated 2.23-fold greater training efficiency despite using 2.3-fold fewer samples. Registration performance also varied significantly across clusters (TRE=0.86-5.47 mm, p<0.001). Conclusion: Acquisition-related batch effects significantly impact AI generalizability in prostate MRI, even among high-quality scans. Quantitative clustering enables detection of technical variations and supports diversity-aware training strategies that achieve equivalent performance with 2.3-fold fewer samples while eliminating batch effects.

Coarse to fine segmentation is a natural strategy for three dimensional lesion delineation becausefull resolution processing of an entire scan is expensive while only a small fraction of the volume contains pathology. Its main failure mode, however, is structural: a lesion missed by the coarse stage is usually absent from the region of interest and therefore cannot be recovered by the fine stage. This problem is most severe for small, low contrast, and multifocal lesions. We introduce RECALLREFINE, a coverage constrained coarse to fine framework that treats candidate-region selection as a recall critical learning problem rather than a deterministic crop around the coarse mask.A full-volume network first predicts coarse lesion probabilities and multi-scale features. A candidate score network then combines coarse probability, predictive uncertainty, feature novelty, and spatial context to score overlapping 3D blocks. During training, a differentiable selector is optimized with a component-wise coverage objective that requires every annotated lesion instance to remain covered by at least one selected block under a fixed refinement budget. Selected blocks are processed at native resolution by a local refiner with a context-ring branch, and overlapping predictions are merged back into the full volume. Across four public 3D lesion benchmarks, RECALLREFINE improves mean tumor Dice from 76.5% for the strongest matched coarse-to-fine baseline to 78.4%, while increasing sensitivity for lesions below 10 mm from 60.9% to 70.8%.At a 20% candidate budget, the selector covers 94.4% of lesion instances, substantially reducing irreversible coarse-stage misses. The results suggest that the central problem in cascaded lesion segmentation is not only how to refine a detected lesion, but how to guarantee that difficult lesions are still represented in the refinement set.

Trans-arterial radioembolization using yttrium-90 (Y-90) microspheres treats unresectable liver cancer with radiation. The tumor-to-parenchyma dose ratio is mainly governed by the patient-specific hepatic arterial flow distribution, which transports the microspheres. Even though computational fluid dynamics (CFD) simulation can predict this flow distribution, its high computational cost and time limit intraprocedural application. To overcome this computational limitation, a physics-informed neural network (PINN) surrogate was developed to provide rapid predictions of flow distribution in a patient-specific hepatic artery model. The surrogate maps spatial coordinates to the velocity vector U with Cartesian components u, v, w and the static pressure p. Reference velocity and pressure fields came from a converged finite-element CFD solve of the same geometry at about 1.05 x 105 nodes; a controlled fraction was used to supervise the training while the remainder was held out for validation. Using the NVIDIA PhysicsNeMo framework, we compared four coordinate networks (MLP, Modified Fourier, Multi-Scale Fourier and SIREN) under soft and hard inlet enforcement across a supervised data sweep (data fraction df = 0 to 0.20) and repeated df = 0.20 at a matched 300,000-step budget. Predicted flow splits were propagated through an established Y-90 dose-kernel pipeline. Accuracy is governed primarily by the supervised-data fraction, not the architecture: at df [&ge;] 0.10 the backbones agree to within one to two R2 points, and R2(u) rises from {approx} 0 under pure physics (df = 0) to {approx} 0.95 by df = 0.01 for the best backbones, saturating near 0.97 to 0.99 by df = 0.20. At a matched 300,000-step budget the Multi-Scale Fourier network leads (R2(u) = 0.978) ahead of SIREN (R2(u) = 0.976) and the MLP (R2(u) = 0.968); the best value seen (R2(u) = 0.985, Modified Fourier) needed 1.8 times that budget. On the df = 0.20 checkpoint the per-outlet flow split matches CFD (r = 0.999, L1 = 4.4 percentage points) and the derived dosimetry agrees to within 2.4% for perfused volume, mean dose and every isodose volume. At df = 0 training collapses toward the trivial near-zero state, which satisfies continuity, momentum and the zero-pressure outlets exactly and is ruled out only by the inlet and data terms; this, not architecture choice, is the limiting failure mode. Once trained, the network evaluates the full 105,284-node field in about 2 s on a four-core CPU. The supervised-data fraction, with a practical floor between df = 0.05 and 0.10, is the primary design lever for such hepatic-arterial PINN surrogates.

Faster ultrahigh-resolution (UHR) photon-counting CT acquisitions facilitate breath-hold imaging, but identical reconstruction settings may conceal differences in spatial resolution. To assess spatial resolution and depiction of small airways and venous stents across helical UHR acquisition configurations. Stationary wire, airway, and venous-stent phantoms underwent one acquisition per configuration using five configurations on a dual-source scanner at 120 kVp. Reconstructions used 0.2- and 0.4-mm thicknesses, the same sharp kernel, and iterative reconstruction strength 1. We measured the full-width at half-maximum of the slice sensitivity profile (SSP) and spatial frequency at 20% of the modulation transfer function (MTF20). Rank-based F tests with Holm adjustment assessed configuration differences in resolution and variability across slices. Airway detection used a profile contrast-to-noise criterion; stent assessment was qualitative. Calculated acquisition time for 400-mm coverage decreased from 9.80 to 1.30 seconds between the slowest and fastest configurations. At 0.2-mm reconstruction thickness, median SSP increased from 0.316 to 0.496 mm, and median MTF20 decreased from 2.870 to 2.059 lp/mm (both P<.001). Interquartile ranges increased from 0.047 to 0.197 mm for SSP and from 0.256 to 0.654 lp/mm for MTF20 (both variability P<.001). Increasing reconstruction thickness to 0.4 mm increased SSP by a median 0.221 mm across 2459 matched slice-wire measurements (P<.001). At 0.2-mm reconstruction thickness, 0.4- and 0.6-mm lumens with 0.2-mm walls were detected only in the slowest configuration. Faster configurations showed less distinct stent struts and greater adjacent-wall distortion. Faster helical UHR photon-counting CT configurations had poorer spatial resolution despite identical nominal slice thickness. Consistent acquisition and reconstruction settings are important for longitudinal comparisons.

Accurate breast lesion segmentation in ultrasound is difficult because speckle noise, heterogeneous lesion appearance, and poorly defined margins can obscure clinically relevant boundaries. This work presents UGB-SegNet, an uncertainty-guided breast ultrasound segmentation network that combines four components: multi-scale convolutional block attention (CBAM) at three EfficientNet-B0 encoder stages, a learnable feature pyramid network for adaptive multi-scale fusion, an entropy-guided decoder that routes fine-grained encoder information toward uncertain regions, and a boundary-aware composite loss with deep supervision. The model was evaluated on the public BUSI dataset (647 annotated lesion images) using a stratified 454/64/129 train/validation/test split. On the held-out test set, UGB-SegNet achieved 81.30% Dice, 68.49% IoU, 81.71% sensitivity, 98.14% specificity, and 15.63-pixel HD95. Under identical training conditions it outperformed five directly trained baselines: U-Net, Attention U-Net, SegNet, DeepLabV3+, and TransUNet. A five-fold resampling experiment over the development set with the held-out test set fixed yielded a mean Dice of 76.36% +/- 1.66% (95% CI 74.90-77.81). Reported ablations attribute gains of +2.06 Dice points to multi-scale CBAM, +1.52 to learnable FPN fusion, +1.22 to the uncertainty-guided decoder, and +1.24 to boundary-aware training. UGB-SegNet contains 14.00M parameters and runs at 62.4 FPS at 224 x 224 resolution on the tested NVIDIA GPU, providing a compact accuracy-efficiency trade-off for future prospective clinical validation.

Biological effectiveness in ion therapy varies with radiation quality and biological context, yet cancer cell response data acquired under well-characterized physical conditions remain limited. We investigated clonogenic survival and relative biological effectiveness (RBE) in PANC-1 and BxPC-3 pancreatic ductal adenocarcinoma (PDAC) cells irradiated at four positions along pristine 180.1 MeV proton and 352.4 MeV/u carbon ion Bragg curves, with 4 cm spread-out Bragg peak (SOBP) irradiation included as a clinically relevant comparison. Cell plane positioning and dose were verified in a water-tank system using an Advanced Markus ionization chamber, and Monte Carlo simulations using TOPAS provided dose-averaged linear energy transfer (LETD) and microdosimetric quantities. RBE was calculated relative to 200 kVp X-rays using the linear-quadratic survival model. Across the sampled pristine beam positions, spanning LETD values of approximately 1-9 keV/m for protons and 12-163 keV/m for carbon ions, RBE increased with LETD. Proton RBE10 exceeded the conventional clinical value of 1.1 at distal positions, whereas carbon ion RBE10 increased from 2.3 to 5.2 in PANC-1 and from 1.3 to 3.7 in BxPC-3, with larger differences between cell lines observed near the Bragg peak. SOBP measurements showed different biological responses across field conditions despite comparable LETD. These physically characterized survival data provide PDAC-relevant benchmarks for evaluating whether RBE models reproduce biological responses across pristine and SOBP irradiation conditions, supporting the future integration of radiation-quality-dependent effects into ion planning.

Purpose: To quantify the sampling error of conventional 2D regions of interest (ROIs) compared with whole-organ 3D volumetric CT attenuation for opportunistic hepatic steatosis screening, and to evaluate its dependency on intraparenchymal spatial heterogeneity. Materials and Methods: In this retrospective computational study (CLAIM-compliant), 971 abdominal CT scans were analyzed across a multicenter derivation cohort (TotalSegmentator v2, n = 841) and an external validation cohort (Medical Segmentation Decathlon Task03, n = 130). Automated 3D liver segmentation was performed using nnU-Net, followed by an 8-mm spherical 3D erosion to eliminate peripheral partial volume effects and major hilar vessels. Three clinical sampling paradigms (1, 3, and 5 axial 2D ROIs of 15 mm diameter) were modeled through 500 stochastic Monte Carlo iterations per scan (485,500 total simulations). Absolute sampling error (|Delta HU| = |HU_ROI - HU_3D|) and diagnostic misclassification rates at the standard <= 40 HU steatosis threshold were computed. Results: In the derivation cohort, the conventional 3-ROI approach yielded a mean absolute error of 6.61 +/- 7.83 HU (median: 2.92 HU), significantly underperforming compared to the 5-ROI strategy (5.21 +/- 6.00 HU; Wilcoxon paired test, p < 0.001) but improving on the single-ROI approach (11.32 +/- 14.16 HU; p < 0.001). Sampling error correlated strongly with parenchymal spatial heterogeneity (Pearson r = 0.850, 95% CI: [0.830-0.868], p < 0.001). In borderline attenuation zones (35-45 HU), diagnostic misclassification reached 45.2% in heterogeneous livers. Findings were corroborated on external validation, confirming the reproducible decay of sampling error (|Delta HU| = 7.38 HU for 1 ROI vs. 5.14 HU for 3 ROI, p < 0.001). Conclusion: Manual 2D ROI sampling exhibits an intrinsic metrological uncertainty exceeding clinically relevant thresholds (5 HU) in heterogeneous livers, misclassifying nearly half of borderline cases. Opportunistic screening requires fully automated 3D volumetric extraction embedded into clinical PACS workflows.

Background and Objective: Micro-ultrasound (MicroUS) is an emerging high-resolution imaging modality for prostate cancer diagnosis and real-time biopsy guidance, but its automated analysis is limited by labor-intensive expert annotation. We aimed to develop and evaluate a foundation model for data-efficient MicroUS image analysis. Methods: We developed muFM, a MicroUS-specific foundation model pretrained using DINOv2-style self-supervised learning on 1,736,391 unlabeled images from 780 patients. The model was fine-tuned and evaluated in three downstream cohorts for prostate capsule segmentation (public, 75 patients), urethra segmentation (institutional, 105 patients), and prostate cancer lesion localization (institutional, 190 patients). Under limited annotation, muFM was compared with randomly initialized models and foundation models pretrained on natural, medical, and ultrasound images. Evaluation used the Dice scores and 95th-percentile Hausdorff distance (HD95) for segmentation and free-response receiver operating characteristic analysis for lesion localization. Key Findings and Limitations: muFM improved performance across all three tasks, with the largest gains under limited annotation. With 10% of training scans, muFM achieved Dice scores of 93.8% for prostate capsule segmentation and 58.4% for urethra segmentation, versus 87.9% and 47.0% for the strongest comparators. Corresponding HD95 values were 2.0 and 4.3 mm. For lesion localization, muFM outperformed other models with approximately 0.75 sensitivity at two false-positive detections per 3D volume. Limitations include retrospective single-institution pretraining and lack of explicit 3D modeling. Conclusions and Clinical Implications: MicroUS-specific self-supervised pretraining improved data-efficient image analysis across prostate and urethra segmentation, and lesion localization. This approach may reduce annotation requirements for developing automated tools in MicroUS image analysis.

Three-dimensional medical image segmentation is unusually heterogeneous in its computational needs: large homogeneous organ interiors are often resolved at coarse scale, whereas small organs, lesions, thin vessels, and ambiguous boundaries benefit from native-resolution processing. Yet modern 3D segmentation networks allocate nearly uniform computation across the entire volume. Existing dynamic-resolution or coarse-to fine methods reduce cost, but typically route regions using hand-crafted image complexity, prediction confidence, or a fixed crop, none of which directly estimates whether spending additional computation on a region will improve the segmentation. We introduce ERRORROUTE, a budgeted inference framework that learns the marginal refinement utility of candidate 3D blocks. A coarse branch first predicts global low-resolution semantics. During training, we estimate for each candidate block the loss reduction achievable by native resolution refinement and supervise a utility estimator to predict this gain before refinement. A differentiable budgeted selector then allocates a fixed compute budget to blocks with the highest expected utility per unit cost, while unselected regions remain on the efficient global path. Selected blocks are refined locally and merged through residual cross-scale fusion. Across six 3D CT/MRI benchmarks, ERRORROUTE achieves a mean Dice of 90.5% at 128 GFLOPs, improving the accuracy-compute frontier over dense 3D baselines and fixed coarse-to-fine systems. At a 30% routing budget, the learned utility estimator recovers 83% of the blocks selected by an oracle router, with the largest allocation concentrated on lesions, small structures, and complex boundaries. These results suggest that efficient medical segmentation benefits from learning where additional computation is useful, rather than merely where the model is uncertain.

Background and purpose: Accurate identification of cardiac MRI volume orientations is essential for reliable image interpretation and for enabling downstream automated analysis pipelines. However, orientation labels and commonly assigned manually, making the process time-consuming and prone to variability. Recent advances in vision-language models offers new opportunities for automated label generation by jointly modeling visual and semantic information. Methods: In this study, we systematically compare a conventional end-to-end transformer-based captioning model with a CLIPCap architecture for automated cardiac MRI view labelling. Both models were evaluated on a dataset of 1184 de-identified cardiac MR images spanning across six clinically relevant orientations: short axis, two-, three-, four-chamber views, left and right ventricular outflow tract views. The caption transformer was trained from scratch, whereas CLIPCap leveraged pretrained CLIP image embeddings combined with lightweight mapping network and a frozen language model. Results: Experimental results demonstrate a substantial performance advantage from CLIPCap, which achieved an overall accuracy of 98% compared to 68% for the caption transformer. CLIPCap consistently delivered high precision and recall across all orientation classes, including those of high clinical importance, while the end to end transformer exhibited unstable performance and complete failure in certain views. Conclusion: These findings highlight the benefits of leveraging large scale multimodal pretrained model for medical image labeling tasks, particularly in data limited settings. The study suggests that CLIPCap provides a more robust and clinically reliable solution for automated cardiac MRI orientation labeling, supporting its integration into efficient and scalable clinical workflows.

Computed tomography (CT) interpretation requires recognition of the anatomical level of each slice. Classification may facilitate preprocessing and AI-assisted fracture diagnosis. We developed deep learning models to classify craniofacial CT slices into six anatomical categories. A total of 11,769 images were collected from a multicenter database involving 10 Japanese university hospitals and the public Head-Neck-Radiomics-HN1 dataset. Patients were divided into training (70%) and evaluation (30%) sets. Five CNN architectures were trained from scratch, and hard- and soft-voting ensembles were evaluated. Individual-model accuracy ranged from 94.72% to 96.09%; the hard-voting ensemble achieved 96.46% accuracy (Cohen's k = 0.954). Although performance differed among individual models (Cochran's Q = 99.29, p < 0.001), the ensemble did not significantly outperform EfficientNetV2B1 (McNemar's p = 0.163). Errors occurred mainly between adjacent anatomical regions. Deep learning can classify craniofacial CT slices accurately and may support automated dataset organization and AI-assisted fracture diagnosis. External validation is needed.

Counterfactual medical images are useful only when a requested clinical change is introduced without silently altering patient characteristics that should remain fixed. Existing diffusion editors can produce convincing images, but realism or target-classifier flips do not establish that an edit is localized, diagnosis-specific, anatomically faithful, or useful on real clinical data. We introduce PATHEDIT, a state-factorized counterfactual editing framework that decomposes an abdominal CT representation into pathology, anatomy, acquisition, and residual context before performing a clinically specified latent intervention. A pathology editor modifies only the target factor, while non-target factors are explicitly copied and preservation losses penalize collateral drift. The edited state is decoded jointly into an image, a report level description, and diagnostic readouts. Weak supervision from lesion masks, organ segmentations, and naturally occurring longitudinal lesion changes anchors edit direction and spatial support without requiring pixel-aligned counterfactual ground truth. We evaluate four properties that are often conflated in medical image editing: target edit success, non-target preservation, anatomical identity, and real-data utility. In our evaluation protocol, PATHEDIT achieves 94.2% target success while reducing mean off-target diagnostic change to 3.0%, yields substantially stronger alignment with observed lesion changes, and improves rare-lesion recognition and shortcut robustness on held-out real CT. These results motivate astricter view of counterfactual medical imaging: a useful edit must prove not only what changed, but also what did not.

Background: Comprehensive evaluations of lung nodule detection methods remain limited, particularly regarding data from clinical routine, novel photon-counting CT (PCCT) technology, and the comparison of academic and commercial models. Materials and Methods: This retrospective study collected 1860 routine PCCT scans acquired at Hannover Medical School from 2021 to 2024. We compared four deep-learning-based lung nodule detection models, which were developed for conventional CT, namely the publicly available TotalSegmentator, nnDetection, and RadYOLO methods, as well as a commercial lung computer-aided detection (CAD) system. We evaluated the inter-model agreement in an unannotated cohort (n=1699), sensitivity in a smaller cohort of 25 manually annotated scans, and false positives as detections in 136 report-negative scans. Results: In the unannotated cohort, the commercial CAD system detected 7071, TotalSegmentator 4264, nnDetection 5254, and RadYOLO 3122 nodules. Overall, the inter-model agreement was low, and the models produced substantially different candidate nodules. Approximately 1300 nodules were detected by all models, representing 18.7% - 42.8% of each model's detections. 15.4% - 37.4% of a model's detections did not match any other model. The models showed moderate sensitivity (between 0.71, 95%-CI [0.64, 0.77], and 0.83, 95%-CI [0.77, 0.88]), and TotalSegmentator and RadYOLO produced few false positives per scan (both 0.85, 95%-CI [0.70, 1.02]). Conclusion: The lung nodules detected by four deep learning models showed high variation and a lack of consensus on clinical PCCT data. These findings highlight the importance of model benchmarking and local validation when deploying models in real-world clinical workflows.

Objectives: Intraoperative ultrasound (IOUS) is an increasingly valuable real-time imaging modality in neurosurgery, enabling visualization of brain parenchyma, tumor margins, ventricular anatomy, and vascular structures during cranial procedures. Despite its clinical relevance, the development of artificial intelligence (AI)-assisted interpretation tools for neurosurgical IOUS has been limited by the scarcity of large, annotated datasets. Manual pixel-level annotation of ultrasound video frames is labor-intensive, requires specialized neuroanatomical expertise, and scales poorly. To address this bottleneck, we developed a proof-of-concept interactive semi-automated annotation pipeline designed to explore the feasibility of scalable, expert-guided labeling for intraoperative neurosurgical IOUS. Methods: We implemented the system as a napari-based graphical interface coupled with a scikit-learn Random Forest (RF) pixel classifier. Real intraoperative neurosurgical ultrasound videos from five craniotomy cases were used as training material. A neurosurgical expert annotated a minimal set of representative frames using brush-based labeling to define anatomical classes of interest. For each labeled pixel, a feature vector was computed comprising raw intensity, multi-scale Gaussian filtering ({sigma} = 1, 2, 3), Laplacian of Gaussian, and Sobel edge magnitude. The RF classifier was trained on accumulated annotations using class-balanced weighting and out-of-bag (OOB) validation, then applied across full video sequences. An incremental accumulator module enabled multi-case training. Segmentation outputs were exported as TIFF overlays for expert quality review. Results: Across five intraoperative cases, sparse expert annotation of a small number of representative frames per case was sufficient to train case-specific Random Forest classifiers that propagated labels across the full video sequences. Out-of-bag estimation served as an internal coherence check during training, and the classifier additionally produced per-class probability maps that exposed regions of uncertainty at acoustic boundaries. On expert qualitative review, the auto-segmented frames were anatomically coherent, with the classifier reliably distinguishing anechoic fluid compartments from echogenic tissue interfaces; residual misclassification was concentrated in low-contrast boundary regions. Conclusions: This proof-of-concept study demonstrates that semi-automated, expert-guided annotation of intraoperative neurosurgical ultrasound is technically feasible using classical machine learning. By combining neurosurgical domain expertise with an interactive, incremental annotation workflow applied to real intraoperative acquisitions, this framework represents a foundational step toward scalable generation of labeled datasets for neurosurgical IOUS. Future directions include formal multi-rater validation, expanded multi-class anatomical labeling, and eventual migration to deep learning architectures as annotated datasets grow.

Diffusion-weighted images are sometimes unavailable or degraded in prostate MRI. We asked whether T2-weighted MRI alone retains usable cancer-related signal and whether the computation can be audited. An image-level transfer-learning ensemble reached out-of-fold AUC 0.883 (95% CI 0.836-0.924) on 243 de-identified institutional T2 images; a handcrafted image-level model reached 0.924 (0.889-0.953) and, in an exploratory external test of 137 Prostate158 patients, 0.643 (0.545-0.734) against 0.494 previously. A volume-level DINOv2-attention model reached AUC 0.717 (0.572-0.853) in 133 held-out biopsy-linked patients, 0.733 with test-time augmentation, and a locked precursor 0.618 (0.566-0.668) in 561 independent PROMIS patients. Distillation reproduced the frozen teacher with R-squared 0.776, a transparent boosting machine 0.678 and a readable model tree 0.550, exposing dependence on gland size, low T2 signal and texture. A bounded dual-agent application gates input quality and anatomy before frozen inference, returning audit metadata. These findings support further evaluation of auditable T2-only analysis when complementary sequences are unavailable or degraded.