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Accurate semantic segmentation for histopathology image is crucial for quantitative tissue analysis and downstream clinical modeling. Recent segmentation foundation models have improved generalization through large-scale pretraining, yet remain poorly aligned with pathology because they treat segmentation as a static visual prediction task. Here we present VISTA-PATH, an interactive, class-aware pathology segmentation foundation model designed to resolve heterogeneous structures, incorporate expert feedback, and produce pixel-level segmentation that are directly meaningful for clinical interpretation. VISTA-PATH jointly conditions segmentation on visual context, semantic tissue descriptions, and optional expert-provided spatial prompts, enabling precise multi-class segmentation across heterogeneous pathology images. To support this paradigm, we curate VISTA-PATH Data, a large-scale pathology segmentation corpus comprising over 1.6 million image-mask-text triplets spanning 9 organs and 93 tissue classes. Across extensive held-out and external benchmarks, VISTA-PATH consistently outperforms existing segmentation foundation models. Importantly, VISTA-PATH supports dynamic human-in-the-loop refinement by propagating sparse, patch-level bounding-box annotation feedback into whole-slide segmentation. Finally, we show that the high-fidelity, class-aware segmentation produced by VISTA-PATH is a preferred model for computational pathology. It improve tissue microenvironment analysis through proposed Tumor Interaction Score (TIS), which exhibits strong and significant associations with patient survival. Together, these results establish VISTA-PATH as a foundation model that elevates pathology image segmentation from a static prediction to an interactive and clinically grounded representation for digital pathology. Source code and demo can be found at https://github.com/zhihuanglab/VISTA-PATH.

Trustworthy clinical summarization requires not only fluent generation but also transparency about where each statement comes from. We propose a training-free framework for generation-time source attribution that leverages decoder attentions to directly cite supporting text spans or images, overcoming the limitations of post-hoc or retraining-based methods. We introduce two strategies for multimodal attribution: a raw image mode, which directly uses image patch attentions, and a caption-as-span mode, which substitutes images with generated captions to enable purely text-based alignment. Evaluations on two representative domains: clinician-patient dialogues (CliConSummation) and radiology reports (MIMIC-CXR), show that our approach consistently outperforms embedding-based and self-attribution baselines, improving both text-level and multimodal attribution accuracy (e.g., +15% F1 over embedding baselines). Caption-based attribution achieves competitive performance with raw-image attention while being more lightweight and practical. These findings highlight attention-guided attribution as a promising step toward interpretable and deployable clinical summarization systems.

Federated learning enables collaborative model training across geographically distributed medical centers while preserving data privacy. However, domain shifts and heterogeneity in data often lead to a degradation in model performance. Medical imaging applications are particularly affected by variations in acquisition protocols, scanner types, and patient populations. To address these issues, we introduce Federated Template and Task Learning (FeTTL), a novel framework designed to harmonize multi-institutional medical imaging data in federated environments. FeTTL learns a global template together with a task model to align data distributions among clients. We evaluated FeTTL on two challenging and diverse multi-institutional medical imaging tasks: retinal fundus optical disc segmentation and histopathological metastasis classification. Experimental results show that FeTTL significantly outperforms the state-of-the-art federated learning baselines (p-values <0.002) for optical disc segmentation and classification of metastases from multi-institutional data. Our experiments further highlight the importance of jointly learning the template and the task. These findings suggest that FeTTL offers a principled and extensible solution for mitigating distribution shifts in federated learning, supporting robust model deployment in real-world, multi-institutional environments.

Deep learning has substantially advanced medical image segmentation, yet achieving robust generalization across diverse imaging modalities and anatomical structures remains a major challenge. A key contributor to this limitation lies in how existing architectures, ranging from CNNs to Transformers and their hybrids, primarily encode spatial information while overlooking frequency-domain representations that capture rich structural and textural cues. Although few recent studies have begun exploring spectral information at the feature level, supervision-level integration of frequency cues-crucial for fine-grained object localization-remains largely untapped. To this end, we propose Phi-SegNet, a CNN-based architecture that incorporates phase-aware information at both architectural and optimization levels. The network integrates Bi-Feature Mask Former (BFMF) modules that blend neighboring encoder features to reduce semantic gaps, and Reverse Fourier Attention (RFA) blocks that refine decoder outputs using phase-regularized features. A dedicated phase-aware loss aligns these features with structural priors, forming a closed feedback loop that emphasizes boundary precision. Evaluated on five public datasets spanning X-ray, US, histopathology, MRI, and colonoscopy, Phi-SegNet consistently achieved state-of-the-art performance, with an average relative improvement of 1.54+/-1.26% in IoU and 0.98+/-0.71% in F1-score over the next best-performing model. In cross-dataset generalization scenarios involving unseen datasets from the known domain, Phi-SegNet also exhibits robust and superior performance, highlighting its adaptability and modality-agnostic design. These findings demonstrate the potential of leveraging spectral priors in both feature representation and supervision, paving the way for generalized segmentation frameworks that excel in fine-grained object localization.

Recent advances in medical vision language models guide the learning of visual representations; however, this form of supervision is constrained by the availability of paired image text data, raising the question of whether robust radiology encoders can be learned without relying on language supervision. In this work, we introduce RadJEPA, a self-supervised framework built on a Joint Embedding Predictive Architecture that learns without language supervision. Pre-trained solely on unlabeled chest X-ray images, the model learns to predict latent representations of masked image regions. This predictive objective differs fundamentally from both image text pre-training and DINO-style self-distillation: rather than aligning global representations across views or modalities, RadJEPA explicitly models latent-space prediction. We evaluate the learned encoder on disease classification, semantic segmentation, and report generation tasks. Across benchmarks, RadJEPA achieves performance exceeding state-of-the-art approaches, including Rad-DINO.

Contrast medium plays a pivotal role in radiological imaging, as it amplifies lesion conspicuity and improves detection for the diagnosis of tumor-related diseases. However, depending on the patient's health condition or the medical resources available, the use of contrast medium is not always feasible. Recent work has explored AI-based image translation to synthesize contrast-enhanced images directly from non-contrast scans, aims to reduce side effects and streamlines clinical workflows. Progress in this direction has been constrained by data limitations: (1) existing public datasets focus almost exclusively on brain-related paired MR modalities; (2) other collections include partially paired data but suffer from missing modalities/timestamps and imperfect spatial alignment; (3) explicit labeling of CT vs. CTC or DCE phases is often absent; (4) substantial resources remain private. To bridge this gap, we introduce the first public, fully paired, pan-cancer medical imaging dataset spanning 11 human organs. The MR data include complete dynamic contrast-enhanced (DCE) sequences covering all three phases (DCE1-DCE3), while the CT data provide paired non-contrast and contrast-enhanced acquisitions (CTC). The dataset is curated for anatomical correspondence, enabling rigorous evaluation of 1-to-1, N-to-1, and N-to-N translation settings (e.g., predicting DCE phases from non-contrast inputs). Built upon this resource, we establish a comprehensive benchmark. We report results from representative baselines of contemporary image-to-image translation. We release the dataset and benchmark to catalyze research on safe, effective contrast synthesis, with direct relevance to multi-organ oncology imaging workflows. Our code and dataset are publicly available at https://github.com/YifanChen02/PMPBench.

The successful adaptation of foundation models to multi-modal medical imaging is a critical yet unresolved challenge. Existing models often struggle to effectively fuse information from multiple sources and adapt to the heterogeneous nature of pathological tissues. To address this, we introduce a novel framework for adapting foundation models to multi-modal medical imaging, featuring two key technical innovations: sub-region-aware modality attention and adaptive prompt engineering. The attention mechanism enables the model to learn the optimal combination of modalities for each tumor sub-region, while the adaptive prompting strategy leverages the inherent capabilities of foundation models to refine segmentation accuracy. We validate our framework on the BraTS 2020 brain tumor segmentation dataset, demonstrating that our approach significantly outperforms baseline methods, particularly in the challenging necrotic core sub-region. Our work provides a principled and effective approach to multi-modal fusion and prompting, paving the way for more accurate and robust foundation model-based solutions in medical imaging.

Early detection of malignant skin lesions is critical for improving patient outcomes in aggressive, metastatic skin cancers. This study evaluates a comprehensive system for preliminary skin lesion assessment that combines the clinically established ABCD rule of dermoscopy (analyzing Asymmetry, Borders, Color, and Dermoscopic Structures) with machine learning classification. Using a 1,000-image subset of the HAM10000 dataset, the system implements an automated, rule-based pipeline to compute a Total Dermoscopy Score (TDS) for each lesion. This handcrafted approach is compared against various machine learning solutions, including traditional classifiers (Logistic Regression, Random Forest, and SVM) and deep learning models. While the rule-based system provides high clinical interpretability, results indicate a performance bottleneck when reducing complex morphology to five numerical features. Experimental findings show that transfer learning with EfficientNet-B0 failed significantly due to domain shift between natural and medical images. In contrast, a custom three-layer Convolutional Neural Network (CNN) trained from scratch achieved 78.5% accuracy and 86.5% recall on median-filtered images, representing a 19-point accuracy improvement over traditional methods. The results demonstrate that direct pixel-level learning captures diagnostic patterns beyond handcrafted features and that purpose-built lightweight architectures can outperform large pretrained models for small, domain-specific medical datasets.

Medical vision-language models can automate the generation of radiology reports but struggle with accurate visual grounding and factual consistency. Existing models often misalign textual findings with visual evidence, leading to unreliable or weakly grounded predictions. We present CURE, an error-aware curriculum learning framework that improves grounding and report quality without any additional data. CURE fine-tunes a multimodal instructional model on phrase grounding, grounded report generation, and anatomy-grounded report generation using public datasets. The method dynamically adjusts sampling based on model performance, emphasizing harder samples to improve spatial and textual alignment. CURE improves grounding accuracy by +0.37 IoU, boosts report quality by +0.188 CXRFEScore, and reduces hallucinations by 18.6%. CURE is a data-efficient framework that enhances both grounding accuracy and report reliability. Code is available at https://github.com/PabloMessina/CURE and model weights at https://huggingface.co/pamessina/medgemma-4b-it-cure

Biomedical research increasingly relies on integrating diverse data modalities, including gene expression profiles, medical images, and clinical metadata. While medical images and clinical metadata are routinely collected in clinical practice, gene expression data presents unique challenges for widespread research use, mainly due to stringent privacy regulations and costly laboratory experiments. To address these limitations, we present GeMM-GAN, a novel Generative Adversarial Network conditioned on histopathology tissue slides and clinical metadata, designed to synthesize realistic gene expression profiles. GeMM-GAN combines a Transformer Encoder for image patches with a final Cross Attention mechanism between patches and text tokens, producing a conditioning vector to guide a generative model in generating biologically coherent gene expression profiles. We evaluate our approach on the TCGA dataset and demonstrate that our framework outperforms standard generative models and generates more realistic and functionally meaningful gene expression profiles, improving by more than 11\% the accuracy on downstream disease type prediction compared to current state-of-the-art generative models. Code will be available at: https://github.com/francescapia/GeMM-GAN