Medical
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When to Unpair: Regulating Pairing Dependence in Medical Visual In-Context Learning
Abstract
Visual in-context learning (ICL), well suited to label-scarce medical imaging, uses support image-label pairs to demonstrate input-output mappings, while the labels collectively indicate the requested task. We diagnose dependence on individual pairings with a test-time derangement that reassigns every support label to another support image while preserving the query, support images, and label multiset. The resulting pairing gap, defined as shuffled-minus-matched performance, shows that all four released models depend on the pairing, to widely varying degrees. Further analysis of a paired-trained model reveals support-associated spurious regions and lesion-size biases even with real, unaltered supports, alongside sensitivity to mis-registered support labels. To regulate this dependence, we introduce a late unpairing curriculum (LUC), which starts with matched training and then applies random unpairing, replacing each support label with that of another support in the same episode. LUC nearly closes the pairing gap on two backbones while maintaining or improving matched-support performance across all evaluated task types, with gains extending to held-out tasks and cross-dataset episodes. It also mitigates these failure modes. On BraTS whole-tumor segmentation, matched-support DSC rises from 0.733 to 0.857 while the gap shrinks from -0.184 to -0.008. In a released model, brief fine-tuning with random unpairing reduces the gap. A reversed curriculum that places the same number of unpairing epochs at the start of training leaves a large gap. This shows that pairing dependence is shaped by the order of training and not only by the amount of unpaired training.
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https://arxiv.org/abs/2610.10335
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Performance at What Cost? A Sustainability-Aware Performance Index for Cell and Nucleus Instance Segmentation
2026-10-07 16:12:53Eiram Mahera Sheikh, Alaa Tharwat, Wolfram SchenckAbstract
Pretrained models for cell and nuclear instance segmentation differ substantially in architecture, pretraining data and objectives, parameter count, inference strategy, adaptation requirements, postprocessing pipeline, and computational demand. Large pretrained and foundation models are increasingly adopted because of their strong zero-shot capabilities, but their use also imposes greater energy consumption, memory requirements, computational demands, adaptation costs, and operational carbon emissions. Whether these additional demands are justified by meaningful gains in segmentation performance remains unclear. We address this question by introducing the Sustainability-Aware Performance Index (SAPI), a configurable metric that combines segmentation performance, energy consumption, and model size. We benchmark 19 pretrained and foundation models across six CellBinDB datasets under zero-shot inference and evaluate 16 fine-tunable models using few-shot adaptation with both frozen encoder and full-model fine-tuning. We estimate energy consumption for GPU, CPU, and RAM using software-based monitoring tools. Our results show that larger and more computationally demanding models do not consistently achieve proportionate improvements in segmentation quality. While few-shot adaptation benefits several models, the gains and resource costs vary considerably across architectures, datasets, and adaptation strategies, causing SAPI-based rankings to differ from rankings based on performance alone. This study provides a practical framework for comparing segmentation models more comprehensively and supports more computationally accessible and environmentally responsible model selection in biomedical image analysis.
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https://arxiv.org/abs/2610.10324
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$Delta$Representation: Geometry Supervised Representation Learning of Phenotypes via Counterfactual Reasoning for Medical VLMs
2026-10-07 15:49:36Hao Wang, Qiwei Zeng, Jinghao Lin, Shuchang Ye, Yuezhe Yang, Yige Peng, Haoyuan Che, Jinman Kim, Lei BiAbstract
Medical vision-language models (VLMs) have shown increasing potential for radiological image interpretation. Medical VLMs encode radiological images into visual representations that capture both anatomical and phenotypic information for diagnosis. Existing approaches improve pathological phenotype representations through semantic-guided representation alignment. However, pathological phenotypes arise as lesion-specific visual changes superimposed on underlying normal anatomy. Such semantic alignment approaches fail to model the phenotype-specific increment relative to the corresponding normal anatomical representation. To address this gap, we propose \textbf{$\Delta$Representation}, a visual phenotype representation learning framework based on counterfactual reasoning for medical VLMs. It comprises \textbf{BaseAnatomy}, a geometry-supervised representation learning module, and \textbf{$\Delta$Phenotype}, a counterfactual incremental representation learning module. BaseAnatomy provides fine-grained geometric supervision through spatial relationships across and within anatomical structures. $\Delta$Phenotype computes the representation increment between lesion representations and their corresponding normal anatomical representations, and supervises increments associated with the same phenotype to cluster in the representation space. Experiments on \textit{ReXGroundingCT} and \textit{LIDC-IDRI} demonstrate that $\Delta$Representation effectively structures pathological phenotype representations and improves lesion grounding and phenotype characterization accuracy in medical VLMs. Code is available at this https URL.
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https://arxiv.org/abs/2610.10286
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Geometry-Supervised Visual Representation Learning for Multi-Phenotype Lesion Interpretation in Medical VLMs
2026-10-07 15:22:11Hao Wang, Qiwei Zeng, Shuchang Ye, Jinghao Lin, Yuezhe Yang, Yige Peng, Jinman Kim, Lei BiAbstract
Medical vision-language models (VLMs) have shown increasing potential for clinical image interpretation. However, these models still struggle to interpret multi-phenotype lesions whose diagnosis requires the joint assessment of multiple pathological phenotypes. Existing vision-language alignment methods produce visual representations that fail to preserve anatomical hierarchies and relationships among phenotypic subclasses. This stems from their reliance on semantic supervision, which lacks geometric constraints to preserve these relationships in the visual embedding space. Moreover, the sparsity of lesion-related anatomical and phenotypic representations makes it difficult for medical VLMs to capture important diagnostic evidence. To address these limitations, we propose \textbf{PureVision}, a geometry-supervised visual representation learning framework for multi-phenotype lesion interpretation in medical VLMs. It combines a geometry-supervised representation learning module, \textbf{PureEyes}, and an anatomy-guided evidence aggregation module, \textbf{PureNeurons}. PureEyes provides geometric supervision through ideal spatial distributions that encode anatomical hierarchies and phenotypic subclass relationships. PureNeurons projects visual representations into the learned latent space, using their positions to selectively aggregate lesion-specific anatomical and phenotypic evidence. Experiments on \textit{LIDC-IDRI}, \textit{CBIS-DDSM}, and \textit{3DReasonKnee} demonstrate that PureVision improves lesion grounding and phenotype characterization in visual question answering and radiology report generation. Code is available at: this https URL.
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https://arxiv.org/abs/2610.10238
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Coverage-Aware Reasoning with Medical Tokens for Diagnosis Prediction
2026-10-07 14:39:18Kaisong Zhang, Haotian Fang, Junmeng Zhou, Hang Lv, Yulan Pan, Yanchao TanAbstract
Large language models (LLMs) offer promising potential for next-visit diagnosis prediction, owing to their ability to integrate longitudinal clinical evidence and reason over it in natural language. However, reinforcement learning for LLM reasoning commonly rewards each trajectory according to the correctness of its final answer. In next-visit diagnosis prediction, multiple diagnoses can be simultaneously valid, but independently rewarding one diagnosis per trajectory does not distinguish repeated hits from coverage of different diagnoses. The policy can therefore concentrate on a few correct diagnoses, leaving others uncovered. Meanwhile, LLM tokenizers can split ICD codes into several generic tokens with limited clinical meaning, requiring multiple decoding steps to predict each diagnosis and hindering reasoning over a large disease vocabulary. To address both challenges, we propose CARing, a framework that represents diagnoses with compositional Semantic IDs (SIDs) and optimizes reasoning trajectories for multi-label coverage. Concretely, we first encode ontology-enriched disease semantics into compact SIDs through residual quantization, and ground the resulting SID tokens in natural language and longitudinal EHR contexts through multi-task alignment and reasoning-enriched training to unlock transferable LLM reasoning. CARing further improves unordered multi-label prediction through a coverage reward for reinforcement learning and multi-positive supervision. At inference time, the model supports both efficient direct constrained decoding and multi-chain reasoning with rank fusion. On MIMIC-III and MIMIC-IV, CARing exceeds all EHR-trained baselines in weighted F1 and attains the highest top-k recall at every reported cutoff, including R@30 of 46.04% and 46.52% in reasoning mode. Our codes and logs are available at this https URL.
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URL
https://arxiv.org/abs/2610.10641
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Sensitive-Topic Leakage Through LLM Routing Metadata: Measurement and Mitigation
Abstract
LLM routers pick a cheap or expensive model per request by its content, and many gateways and some cloud platforms can log that choice with content logging off. We measure this privacy channel beyond token counts, accounting for noisy labels and repeated prompts. We run pre-registered studies on 1.7 million real requests (WildChat-1M, LMSYS-Chat-1M) with two cost/quality routers and a domain router, survey eleven systems' logging, and test post-processing defenses. At matched length, the shift's direction depends on category and router. For RouteLLM at the 50% operating point, harassment and self-harm requests reach the strong model 19 points less often than comparable ones on prompts unseen in exploration, medical requests (exploratory: LLM labels failed their gate) 31 points less often on distinct prompts (both post hoc), and sexual requests 10 points more often (secondary); the other router's four are negative. Twenty RouteLLM decisions separate frequent medical askers with AUC 0.71, exploratory and below the pre-registered primary endpoint's 0.75 (domain router: 0.92, an upper estimate). Per-category length-matched parity with accurate labels removes the gap on real traffic, costing at most 0.2 accuracy points on RouterBench (post hoc), where routers' gaps on sensitive subjects (13-42 points, pre-registered) exceed those of an oracle routing by realized accuracy gain (1-11, post hoc). Per-conversation stickiness, per-user budget bands, and pooled parity fail, the last as categories' shifts differ in size or sign. A post hoc exact per-user rate hides only even-prefix strong counts and forfeits most self-assessed routing value; it preserves odd-position decisions, from which a post hoc log attack reaches AUC 0.73 after 20 RouteLLM requests (exploratory).
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https://arxiv.org/abs/2610.09981
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FedSSMCoOp: SSM Encoders for light-weight Federated Prompt Learning for Few-shot Classification
2026-10-07 12:00:59Ankita Das, Ambarish Parthasarathy, Sumohana S. Channappayya, C. Krishna MohanAbstract
Vision-Language Models (VLMs) have shown strong performance across a wide range of downstream vision tasks, thanks to the complementary information contained in the respective domains. Despite the performance gains, most of these approaches rely on aligning these domains using the cosine similarity metric, which fails to capture token-level structure and cross-modal interactions prior to the classification stage. This is especially critical in biomedical applications under federated constraints, where data sharing is restricted, labeled data is scarce at each site, and it differs widely across institutions, leading to substantial statistical heterogeneity. To overcome this issue, we propose FedSSMCoOp, a federated few-shot image classification framework that enables multimodal learning while preserving data privacy. With the help of the SSM-based Vision Mamba and Cross Mamba blocks, and by optimizing only the soft-prompt and communication-prompt updates in the federated setting, the framework prioritizes both computation and performance. Importantly, this eliminates the need to use an external Large Language Model (LLM) for feature alignment. The framework is further trained and evaluated on various biomedical image datasets, and its performance is assessed. The proposed framework delivers stable performance relative to the baselines and is, on average, 1.96 times lighter. The corresponding script will be made available soon.
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URL
https://arxiv.org/abs/2610.09907
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A Multi-Source Ultrasound Benchmark Revealing the Limits of Contemporary Self-Supervised Anomaly Detection Methods
2026-10-07 08:39:51Marco Riedenauer, Daniel Kienzle, Pratik Mayekar, Rainer LienhartAbstract
Self-supervised anomaly detection is a promising paradigm for medical ultrasound, as normal images are often easier to obtain than exhaustive annotations of all possible pathologies. However, most existing evaluations are limited to a single anatomy or task, making it unclear whether models learn a robust notion of normal ultrasound appearance or only a source-specific representation. We introduce the SADUSI benchmark, a multi-source ultrasound dataset designed to train and evaluate anomaly detection methods across a broad range of anatomical regions, views, and acquisition protocols. The goal of SADUSI is to provide a diverse normal ultrasound distribution and a benchmark for visible structural anomalies that can be assessed from single images. We evaluate representative self-supervised anomaly detection methods and find that current approaches struggle in this setting. In particular, reconstruction-based diffusion methods such as AnoDDPM and DeCo-Diff achieve pixel-level AUROC values of 0.56-0.72 and maximum F1 scores of 0.10-0.26, indicating limited separation of pathology from normal image regions. Feature-based PatchCore variants perform better, reaching pixel-level AUROC values of 0.76-0.83, but remain limited with maximum F1 scores of 0.14-0.40. These findings suggest that broad multi-source ultrasound anomaly detection remains an open challenge and that SADUSI can serve as a resource for developing methods that generalize beyond anatomy-specific settings.
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https://arxiv.org/abs/2610.09677
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Quasi-Binarized Autoencoders: An Architecture-Independent Information Bottleneck for Medical Image Anomaly Detection
2026-10-07 08:34:40Shouhei Hanaoka, Takahiro Nakao, Atsushi Takamatsu, Takeharu Yoshikawa, Osamu AbeAbstract
Unsupervised anomaly detection, which learns only from normal images, is a central task in medical image analysis and remains an open problem. Reconstruction-based methods pass an image through an encoder-decoder network trained on normal data and detect anomalies from the residual between the image and its reconstruction. This works only if the information passed from the encoder to the decoder is limited; otherwise the network learns an identity mapping and reconstructs anomalies too. This limit is usually imposed through architectural choices, tuned per dataset, that cannot be stated in bits. We introduce the quasi-binarizing (QB) layer, which squashes each latent element into [0, 1] and adds Laplace noise of scale 1/epsilon. Each element is then epsilon-locally differentially private, and the mutual information between an image and its reconstruction is bounded by a quantity that depends only on epsilon and the number of QB elements, whatever the encoder and decoder. Placing a QB layer on every encoder-decoder path, including all skip connections, we build QBAE, a seven-level attention U-Net with 32,768 QB elements. On the seven datasets of the MedIAnomaly benchmark, QBAE with one architecture and one configuration reaches a mean image-level AUROC of 0.828, the highest among methods that do not adapt to each dataset, and the best reported results on BraTS2021 (AUROC 0.911, pixel-level AP 0.838). The noise is kept at test time, so that every reconstruction satisfies the bound. Without input corruption, the bottleneck alone prevents identity collapse (mean AUROC 0.805 vs. 0.590). Code is available at this https URL.
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URL
https://arxiv.org/abs/2610.09670
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Identity-Duplication Auditing in National-Scale Neuroimaging Repositories
2026-10-07 07:57:11Jiheng Li (HABS-HD), Michael E. Kim (HABS-HD), Trent M. Schwartz (HABS-HD), Yuhan Cui (HABS-HD), Gaurav Rudravaram (HABS-HD), Derek B. Archer (HABS-HD), Timothy J. Hohman (HABS-HD), Lori L. Beason-Held (HABS-HD), Victoria L. Morgan (HABS-HD), Dario J. Englot (HABS-HD), Angela L. Jefferson (HABS-HD), for the Alzheimer's Disease Neuroimaging Initiative (HABS-HD), for the BIOCARD Study team (HABS-HD), for the Health (HABS-HD), Aging Brain Study (HABS-HD), (HABS-HD), Health Disparities (HABS-HD), Study Team, Lianrui Zuo, Guray Erus, Christos Davatzikos, Bennett A. LandmanAbstract
National-scale magnetic resonance imaging (MRI) repositories increasingly integrate data from different studies and institutions. However, subject identifiers that are valid only within individual datasets are no longer guaranteed to remain globally unique after aggregation, making it possible for the same subject to be assigned multiple identifiers, which we define as identity duplication. Such duplication can create leakage between training and test data and inflate apparent performance in downstream biomedical studies. Existing methods do not provide an end-to-end, image-based workflow for auditing this problem at repository scale. In this work, we present HAPPEN, a human-in-the-loop pipeline for auditing identity duplication in T1-weighted brain MRI repositories. It combines SHA-256 fingerprinting for exact-duplicate detection with supervised contrastive retrieval of non-identical scans that may originate from the same person. Retrieved pairs are reviewed as candidates in a locally hosted interface rather than automatically classified as duplicates. We deployed the workflow in a 95,129-scan aggregated repository and assessed end-to-end recovery using 54 genetic-reference pairs. Transferability was assessed by locally deploying the same workflow on 22,386 scans at an independent institution without model retraining or image transfer. Deployment in the study repository identified 1,316 exact-duplicate scan groups and 1,275 reviewer-supported near-duplicate subject groups. Of these groups, 56% and 82%, respectively, crossed dataset boundaries. All 54 genetic-reference pairs were recovered. The external team independently completed the full workflow using a locally selected operating threshold and review standard.
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URL
https://arxiv.org/abs/2610.09614
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Quantifying Volumetric Risk: Class-Aware Asymmetric Weighted Conformal Prediction for 3D Medical Image Segmentation
2026-10-07 03:51:16Shadi Alijani, Fereshteh Aghaee Meibodi, Homayoun NajjaranAbstract
Reliable volumetric segmentation is critical for clinical diagnostics, yet foundation models such as MedSAM remain deterministic and lack calibrated uncertainty under distribution shift. Existing conformal prediction methods offer statistical guarantees but are frequently applied in 2D and assume symmetric error distributions, so they do not capture the class-specific biases that arise in 3D multi-class segmentation. We propose Class-Aware Asymmetric Weighted Conformal Prediction (CA-WCP), which combines latent-space density-ratio weighting for covariate shift with directional quantiles for the lower and upper volume bounds, and scales each bound by a class-specific asymmetry factor derived from validation-set false-positive and false-negative rates. We prove that CA-WCP retains the weighted-exchangeability marginal coverage guarantee for every class, and we evaluate it on 3D brain tumor segmentation (BraTS 2020) and on a synthetic multi-organ CT benchmark constructed under covariate shift. On both benchmarks the 95\% Clopper--Pearson interval for the observed coverage of CA-WCP contains the nominal 90\% level for every semantic class, while interval width is reduced by 8--14\% relative to symmetric weighted conformal prediction. We further encode the calibrated intervals into structured prompts for a multimodal large language model to produce uncertainty-conditioned radiology reports, linking distribution-shift-aware uncertainty quantification to interpretable clinical communication.
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URL
https://arxiv.org/abs/2610.09392
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InfiMed2: A Generalist Medical Multimodal Foundation Model from Contextual Evidence and Stability-Aware Supervision
2026-10-07 03:24:07Guanghao Zhu, Zeyu Liu, Zhitian Hou, Pengkai Wang, Zhijie Sang, Shuo Cai, Yang Yu, Yuanyi Wang, Yanggan Gu, Congkai Xie, Jianmin Wu, Hongxia YangAbstract
Recent medical multimodal models have benefited from larger corpora, broader modality coverage, and stronger reasoning-oriented training, yet effective data design across continued pretraining (CPT) and post-training remains challenging. Medical sources vary substantially in structure, granularity, and information density, and their utility shifts as training progresses from broad knowledge acquisition to late-stage consolidation. Meanwhile, post-training is often dominated by short-form visual question answering, providing limited supervision for informative and answer-consistent explanations. We introduce InfiMed2, a family of 4B and 27B generalist medical multimodal foundation models built around stage-aware data design. We curate a 55.68B-token corpus that combines broad clinical knowledge with context-rich biomedical visual evidence through source-specific processing. Our CPT pipeline first adapts the vision encoder, then builds broad medical knowledge, and finally transitions to an evidence-focused data mixture during learning-rate decay. For supervised fine-tuning (SFT), we regenerate visual question-answering responses using answer stability, answer-masked reconstruction, and correctness-constrained selection to produce more informative and answer-consistent supervision. The 4B model is further optimized with reinforcement learning with verifiable rewards (RLVR). Across five medical multimodal benchmarks, InfiMed2-4B achieves 66.73% mean accuracy after RLVR, surpassing the larger Qwen3.5-9B, while InfiMed2-27B reaches 73.72%, the highest among the evaluated open-weight models.
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https://arxiv.org/abs/2609.34798
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Beyond Explanation: Debugging Medical Imaging Models via Concept Intervention
2026-10-06 19:31:42Samrajya Thapa, Daniel J. Quest, Timothy L. Kline, Carrie L. Langstraat, Emanuel C. Trabuco, Wei LeAbstract
Medical imaging models often operate as black boxes, limiting interpretability and systematic debugging. We introduce an easy-to-use, plug-and-play framework for concept-based interpretation and model refinement. By aligning a single-modality encoder to BioMedCLIP, we construct a Concept Bottleneck Model (CBM) that enables concept-level interventions. These interventions allow us to isolate causal versus spuriously correlated concepts, validate insights with domain experts, and generate counterfactual samples for targeted fine-tuning. We evaluate our framework on a Mayo Clinic ultrasound dataset and the CheXpert 5x200 chest X-ray dataset. Results demonstrate that concept intervention enables reliable model diagnosis while maintaining, and occasionally improving predictive performance via guided fine-tuning. Our findings highlight the practical value of this framework for controlled, interpretable refinement of clinical deep learning models.
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URL
https://arxiv.org/abs/2610.09031
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Evidence-Bound Reasoning: Neuro-Semantic Verification of Biomedical AI in Glioblastoma Radiogenomics
2026-10-06 16:44:02Mariya Miteva, Maria Nisheva-PavlovaAbstract
Background: Biomedical AI can generate plausible explanations without reliably verifying whether each statement is supported by patient-specific evidence. We developed a neuro-semantic verification framework that converts radiomic measurements into addressable evidence records and machine-checkable claims. Methods: UPenn-GBM radiomics were aligned with de novo CaPTk extraction from standardized MRI and expert-validated segmentations in an independent multicenter cohort. The shared space comprised 1,728 features from T1, T1GD, T2, and FLAIR MRI across three tumor regions. Reference-defined semantic states were derived from 611 UPenn cases. We evaluated cross-cohort transportability, model-linked provenance, deterministic verification, controlled predictive degradation, and an LLM claim-extraction pilot; MGMT prediction served only as a transport stress test. Results: Median semantic-state agreement was 0.786 (weighted kappa 0.709), ranging from 0.918 for morphologic to 0.252 for intensity features. The external evidence ledger contained 1,655 model-linked records for 331 patients. The verifier achieved 100% exact-set accuracy in a 6,620-claim corruption benchmark. In a 24-case pilot, GPT-5.6 Sol reproduced 72/72 prespecified atomic claims, and the frozen verifier recovered 24/24 expected conditions. During controlled degradation, ROC AUC declined from 0.899 to 0.500 while verification accuracy remained 1.000. External MGMT discrimination was weak (ROC AUC 0.543). Conclusions: Verifiability can be engineered and evaluated independently of predictive performance. LLMs may structure explanations, while final evidence-consistency checking remains deterministic.
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https://arxiv.org/abs/2610.08660
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FedDermaSeg: Federated Learning for Dermatological Image Segmentation
2026-10-06 15:49:04Anabik Pal, Ganesh Patidar, Bikash SantraAbstract
Skin cancer is a major global health concern, and early detection and accurate lesion delineation are important for effective diagnosis and treatment planning. Automated skin lesion analysis can assist dermatologists, with lesion segmentation serving as a fundamental step in computer-aided diagnostic systems. Conventional deep learning-based segmentation models typically rely on centralized training, where images and their corresponding segmentation masks are collected on a central server. Such data aggregation raises privacy concerns in medical applications and requires substantial centralized computational resources. To address these limitations, we investigate the feasibility of federated learning for privacy-preserving skin lesion segmentation. The training and validation sets of the ISIC 2018 Skin Lesion Segmentation Challenge dataset are used to simulate a distributed learning environment and develop a federated segmentation model. The resulting model is evaluated on the ISIC 2018 test set and the PH2 dataset to assess its performance and generalizability. Experimental results demonstrate that the federated model achieves performance comparable to centralized training while consistently improving upon the locally trained models. These findings demonstrate the potential of federated learning for collaborative skin lesion segmentation without requiring centralized aggregation of medical images.
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https://arxiv.org/abs/2610.08574
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MedCORE: Criteria-Grounded Clinical Reasoning for Interpretable Medical Image Diagnosis
2026-10-06 15:23:01Asim Khan, Samee Ullah Khan, Dwarikanath MahapatraAbstract
Clinical diagnosis is inherently a structured reasoning process, yet existing deep learning models often bypass this structure by mapping image features directly to disease labels without explicitly interrogating the morphological and textural criteria that clinicians systematically evaluate. This limits diagnostic transparency and may compromise safe clinical deployment. We present MedCORE (Medical Criteria-Oriented Reasoning and Evidence), a structured diagnostic framework that operationalizes clinical reasoning within a vision-language architecture. For each input image, MedCORE decomposes the diagnostic process into clinically defined criteria, spatially localizes each criterion to diagnostically relevant image regions, encodes evidence through multi-scale representations that capture macro-structural and micro-textural pathological characteristics, and refines criterion representations using a Graph Attention Network that explicitly models inter-criteria dependencies. Criterion representations are further aligned with clinical text descriptors, reinforced through class-wise visual prototypes, and aggregated using uncertainty-calibrated weighting that proportionally discounts low-confidence diagnostic evidence. MedCORE is validated across three clinically heterogeneous imaging modalities, including dermoscopic lesion classification on ISIC 2018, breast ultrasound lesion characterization on BUSI, and diabetic retinopathy grading on IDRiD. Quantitatively, MedCORE achieves 89.2% accuracy, 85.7% macro-F1, and 96.4% AUC on ISIC 2018; 96.1% accuracy, 95.2% macro-F1, and 98.4% AUC on BUSI; and 84.3% accuracy, 80.2% macro-F1, and 92.8% AUC on IDRiD. These results demonstrate consistent improvements over strong CNN, transformer, biomedical vision-language, concept-based, and prototype-based baselines.
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https://arxiv.org/abs/2610.08528
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Knee3DVLM: Dual-Sequence Full-Volume Vision-Language Modeling for Comprehensive Knee MRI Assessment
2026-10-06 14:58:53Maryam Baizhigitova, Andrew Seohwan Yu, Po-Hao Chen, Naveen Subhas, Sixu Chen, Xinxin Wang, Kunio Nakamura, Richard Lartey, Xiaojuan Li, Mingrui YangAbstract
Vision-language models (VLMs) are increasingly being applied to three-dimensional medical imaging, but their application to knee MRI remains limited, particularly for interpreting the complementary sequences used in clinical practice. We introduce Knee3DVLM, a sequence-aware VLM that uses full-volume DESS and fluid-sensitive TSE MRI to predict 57 anatomically resolved binary diagnostic targets derived from the MRI Osteoarthritis Knee Score (MOAKS) for structured reporting. We evaluated DESS-only, TSE-only, and paired DESS-TSE configurations using subject-disjoint Osteoarthritis Initiative partitions. In a held-out cohort of 1,074 examinations, the fused model achieved 72.98% average accuracy, 71.17% balanced accuracy, 78.96% mean ROC-AUC, and 78.74% macro ROC-AUC, the highest values among the three configurations. In a secondary multiclass analysis aligned with the released 3DReasonKnee cohort, Knee3DVLM was numerically higher than the strongest reported 3DReasonKnee configuration across five pathology categories. These findings support dual-sequence full-volume modeling for comprehensive knee MRI assessment.
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https://arxiv.org/abs/2610.08482
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From the Drosophila Visual Connectome to General-Purpose Computer Vision
2026-10-06 14:22:00Zongyu Li, Akito Yamauchi, Huaizhi Liu, Vishwanatha Rao, Jia Guo, for the Frontotemporal Lobar Degeneration Neuroimaging Initiative, for the Alzheimer's Disease Neuroimaging InitiativeAbstract
Biological connectomes encode structured solutions to visual computation that may provide reusable inductive biases for artificial vision. We develop ConnectomeX around FlyVision, a trainable architecture that preserves parallel ON/OFF processing, recurrent computation and population-level graph interaction while scaling model capacity across tasks. FlyVision reached 99.34% accuracy on MNIST with 80,608 parameters and 78.03% on CIFAR-10 with 81,408 parameters. On ImageNet-1K, FlyVision Base and Large reached 60.79% and 66.25% top-1 accuracy with 1.8 and 3.7 million parameters, while a Large local-k7 model with a learned low-frequency branch reached 66.53%, compared with 69.25% for ResNet18 with 11.7 million parameters. On a 22-class skin-disease benchmark, FlyVision Large achieved 63.78% accuracy and 95.28% macro-AUROC with 2.99 million parameters. In four-class chest radiography, ImageNet-pretrained FlyVision Base and Large reached 92.60% and 92.76% accuracy with 1.33 and 2.97 million parameters, compared with 91.56% for ImageNet-pretrained ResNet18 with 11.18 million. BrainAGE extends FlyVision to volumetric T1-weighted MRI by applying a shared ImageNet-pretrained FlyVision Large encoder to 24 sagittal, coronal and axial slices per scan and combining slice-level age estimates by confidence-modulated Gaussian voting. On 433 held-out scans, three-axis fusion achieved a mean absolute error of 5.98 years and R^2 = 0.868. Across the 224x224 classification tasks, the best FlyVision configuration remained within three percentage points of ResNet18 on ImageNet-1K and skin-disease classification and exceeded it on chest radiography with substantially fewer parameters. These results show that a conserved connectome-informed computation can scale from compact recognition to large-scale natural and biomedical vision.
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https://arxiv.org/abs/2610.08418
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UP-MOPD: Update Projection in Multi-Teacher On-Policy Distillation
2026-10-06 14:13:31Taojie Zhu, Jing Jin, Yuan Xia, Chenyang Ding, Qunshan He, Wanke Xia, Tao Sun, Yan Chen, Jian Wang, Jinjie Gu, Tao FengAbstract
On-policy distillation from multiple teachers combines expertise from different domains in a single student, but conflicting gradients can hinder this integration. Gradient corrections directly constrain parameter updates under plain SGD. With optimizers such as AdamW, however, momentum, adaptive scaling, and weight decay can turn a corrected gradient into an update that increases a domain loss to first order. To address this gap, we propose Update Projection for Multi-Teacher On-Policy Distillation (UP-MOPD). UP-MOPD lets the original mixed gradient update the optimizer state and generate a candidate displacement, then projects only violating candidates before they are committed to the parameters. The projection gives the unique feasible update closest to the candidate in Euclidean distance. In experiments combining medical and general domains, UP-MOPD improves IFEval-loose accuracy late in training by 2.96 points over vanilla M-OPD. It achieves an average score of 60.03 across eight metrics, compared with 59.00 for gradient projection and 59.15 for update rejection. On a public benchmark covering mathematics, code, and instruction following, it achieves the best average across six tasks (32.67), leads on LiveCodeBench v5, and ties for the best IFEval this http URL results support projecting optimizer updates to reduce interference between domains.
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URL
https://arxiv.org/abs/2610.08398
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MedZERO: Self-Evolving Agents for Open-Ended Medical Reasoning Through Controlled Knowledge Accumulation
2026-10-06 13:25:55Xilin Dang, Weilin Ruan, Xue Yang, Jinghao Wang, Xiaowei Hu, Jinpeng Li, Pheng-Ann HengAbstract
Large language models (LLMs) have shown promise in medical question answering and clinical reasoning, yet their improvement remains constrained by static parametric knowledge and costly expert supervision. Self-evolving agents offer a promising alternative by enabling models to improve through iterative task generation and problem-solving. However, most existing self-evolving methods are designed for easily verifiable domains such as mathematics and coding, where solutions can be checked by exact answers or executable programs. Medical reasoning is fundamentally different: it is open-ended, knowledge-intensive, and often only partially verifiable. We present MedZERO, a self-evolving framework for open-ended medical reasoning. MedZERO couples an Examiner that generates frontier medical question-option pairs with a Reasoner that solves them through evidence-grounded multi-turn reasoning with external knowledge tools. To support reliable, continual improvement, MedZERO adopts controlled knowledge accumulation, which maintains temporary exploratory knowledge and curated persistent knowledge in reasoning. We evaluate MedZERO on five public medical reasoning benchmarks using 4B- and 8B-scale base models under open-ended evaluation. Across all settings, MedZERO consistently outperforms the underlying base models and prior self-evolving baselines, achieving up to 13.7 average accuracy-point gains over the next-best self-evolving baseline.
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https://arxiv.org/abs/2610.08327
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