Find the papers that actually matter

Melanoma remains one of the most aggressive and lethal cutaneous malignancies, underscoring the need for objective and label-free diagnostic methods that complement traditional histopathology. In this study, Laser-Induced Breakdown Spectroscopy (LIBS) and Raman spectroscopy were jointly applied to characterize formalin-fixed paraffin-embedded (FFPE) melanoma and normal human tissues, and the resulting spectra were modeled using an Extreme Learning Machine (ELM) under five activation functions. Model interpretability was achieved through SHapley Additive exPlanations (SHAP) analysis. Among the tested activation functions, the average test accuracies were achieved by sine for LIBS (92.43%) and sigmoid for Raman (74.41%) under stratified spectrum-wise cross-validation, while feature-level fusion achieved 77.88% average test accuracy with sigmoid. SHAP analysis revealed that K (∼766/769 nm) and Ca (∼422 nm) emission lines in LIBS and ∼ 3164 and ∼ 1163 cm-1 bands in Raman were the dominant discriminative features, corresponding to ionic imbalance, calcium signaling dysregulation, as well as protein conformational changes (amide A/N-H stretching) and protein-lipid-associated C-C/C-N vibrational alterations characteristic of melanoma progression. These results establish a coherent and interpretable framework linking spectral signatures to biochemical mechanisms and demonstrate the potential of compact, multimodal, and mechanism-driven optical diagnostics for precise, transparent cancer assessment.

The difference in molecular characteristics of Triple negative breast cancer (TNBC) aids in distinguishing between its four prominent subtypes- basal-like 1, basal-like 2, mesenchymal, and luminal androgen receptor. This study presents the first integrative framework that combines explainable AI with machine learning approaches to classify TNBC subtypes. Unlike conventional models, our approach offers interpretability while enabling biomarker prioritization by identifying key hub genes that drive subtype-specific predictions. In the experiment 783 cases (BL1 (160), BL2 (75), M (151), LAR (106), non-TNBC (291) reported in Gene Expression Omnibus (GEO) and Genomic Data Commons (GDC) data portal were used for the analysis. The proposed framework comprises modules for the identification of gene signatures for the four-subtype followed by the classification model based on eight different machine learning algorithms. Random Forest classifier was found to be best model with 96 % testing accuracy, which was elected for Explainable framework using Shapley Additive Explanations. Explainable biomarker module could provide a set of 47 biomarkers which is relevant in distinguishing the four types on triple negative breast cancer. The biomarkers could have the potential to be considered for TNBC prognosis in clinical setting. Key findings highlight the hub genes CDC20, CDCA2, PIMREG, KIF2C, and CENPW, implicating pathways such as ubiquitin-proteasome signaling and microtubule dynamics. These insights pave the way for biomarker-driven therapies and precision medicine in triple negative breast cancer.

Computed tomography (CT) images are frequently degraded by acquisition artifacts, including noise, blur, streaking, aliasing, and metal artifacts. Yet CT enhancement is still largely evaluated using image quality metrics with limited perceptual and clinical validity, while existing datasets remain focused on isolated restoration tasks, hindering unified benchmarking across diverse degradation types. We present CT-DegradBench, a dataset and benchmark for CT degradation detection and severity estimation under controlled single- and mixed-artifact settings. CT-DegradBench enables systematic evaluation across multiple degradation families and severity levels within a common experimental framework. We further propose SeSpeCT (Semantic-Spectral CT degradation estimation), a framework that combines semantic priors from medical vision-language models with complementary frequency-domain cues for artifact analysis. SeSpeCT constructs a training-free semantic quality axis in the multimodal embedding space using radiology-informed text prompts, without task-specific fine-tuning, and combines it with spectral features that capture degradation-specific frequency patterns. The resulting representation enables joint prediction of artifact type and severity. Experimental results show that SeSpeCT consistently outperforms the evaluated baselines under both single- and mixed-degradation settings. The framework is available at https://github.com/yousranb/CT-DEGRADBENCH.

Ovarian cancer is the most lethal gynecologic malignancy: around 60% of patients are diagnosed at an advanced stage, with an associated 5-year survival rate of about 30%. Early identification of non-responders to neoadjuvant chemotherapy remains a key unmet need, as it could prevent ineffective therapy and avoid delays in optimal surgical management. This work proposes a non-invasive deep learning framework to predict neoadjuvant chemotherapy response from pre-treatment contrast-enhanced CT by leveraging automatically derived 3D lesion masks. The approach encodes axial slices with a partially fine-tuned pretrained image encoder and aggregates slice-level representations into a volumetric embedding through an attention-based module. Training combines classification loss with supervised contrastive regularization and hard-negative mining to improve separation between ambiguous responders and non-responders. The method was developed on a retrospective single-center cohort from the European Institute of Oncology (Milan, IT), including 280 eligible patients (147 responder, 133 non-responder). On the test cohort, the model achieved a ROC-AUC of 0.73 (95% CI: 0.58-0.86) and an F1-score of 0.70 (95% CI: 0.56-0.82). Overall, these results suggest that the proposed architecture learns clinically relevant predictive patterns and provides a robust foundation for an imaging-based stratification tool.

A main barrier for the deployment of AI radiomic systems in clinical routine is their drop in performance under heterogeneous multicentre acquisition protocols. This work presents a performance-oriented framework for quantifying scan parameter sensitivity of radiomic AI models, while identifying clinically significant parameter regions associated with improved cross-dataset robustness. We formulate a mixed-effects framework for quantifying the influence that clinically relevant acquisition parameters have on models performance, while accounting for subject-level random effects. We have applied our framework to lung cancer diagnosis in CT scans using two independent multicentre datasets (a public database and own-collected data) and several SoA architectures. To evaluate across-database reproducibility, CT parameters have been adjusted using the data collected and tested on the public set. The optimal configuration selected is the current of the X-ray tube >= 200 mA, spiral pitch <= 1.5, slice thickness <= 1.25 mm, which balances diagnostic quality with low radiation dose. These configuration push metrics from 0.79+-0.04 sensitivity, 0.47+-0.10 specificity in low quality scans to 0.90+-0.10 sensitivity, 0.79 +- 0.13 specificity in high quality ones.

Purpose: Mechanical thrombectomy (MT) improves stroke outcomes, but is limited by a lack of local treatment access. Widespread distribution of reinforcement learning (RL)-based robotic systems can be used to alleviate this challenge through autonomous navigation, but current RL methods require live device tip coordinate tracking to function. This paper aims to develop and evaluate a real-time catheter tip tracking pipeline under fluoroscopy, addressing challenges such as low contrast, noise, and device occlusion. Methods: A multi-threaded pipeline was designed, incorporating frame reading, preprocessing, inference, and post-processing. Deep learning segmentation models, including U-Net, U-Net+Transformer, and SegFormer, were trained and benchmarked using two-class and three-class formulations. Post-processing involved two-step component filtering, one-pixel medial skeletonization, and greedy arc-length path following with contour fall-back. Results: On manually-labeled moderate complexity fluoroscopic video data, the two-class SegFormer achieved a mean absolute error of 4.44 mm, outperforming U-Net (4.60 mm), U-Net+Transformer (6.20 mm) and all three-class models (5.19-7.74 mm). On segmentation benchmarks, the system exceeded state-of-the-art CathAction results with improvements of up to +5% in Dice scores for three-segmentation. Conclusion: The results demonstrate that the proposed multi-threaded tracking framework maintains stable performance under challenging imaging conditions, outperforming prior benchmarks, while providing a reliable and efficient foundation for RL-based autonomous MT navigation.

Volumetric Modulated Arc Therapy (VMAT) is a cornerstone of modern radiation therapy, enabling highly conformal tumor irradiation and healthy-tissue sparing. Yet, its planning solves inverse and nested optimization for multi-leaf collimators, monitor units and dose parameters, while enforcing their consistency to ensure mechanical deliverability. Nevertheless, this process often requires repeated re-optimization when treatment configurations change, resulting in substantial planning time per patient. To address these problems, we present a diffusion-driven Learning-to-Optimize (L2O) method for end-to-end VMAT planning. A distribution-matching distilled diffusion model learns a clinically feasible manifold of fluence maps, enabling their one-shot generation. On top of this, an LSTM-based L2O module learns gradient update dynamics to swiftly refine fluence maps toward prescribed dose objectives during inference. Experimental results on clinical and public prostate cancer cohorts demonstrate improved planning efficiency, flexibility, and machine deliverability over currently available end-to-end VMAT planners.

Medical image-to-image (I2I) translation enables virtual scanning, i.e. the synthesis of a target imaging modality from a source one without additional acquisitions. Despite growing interest, most proposed methods operate on 2D slices, are evaluated on isolated tasks with different experimental set-ups and lack clinical validation. The primary contribution of this work is a reproducible, standardized comparative evaluation of 3D I2I translation methods in oncological imaging, designed to standardize preprocessing, splitting, inference, and multi-level evaluation across heterogeneous clinical tasks. Within this framework, we compare seven generative models, three Generative Adversarial Networks (GANs: Pix2Pix, CycleGAN, SRGAN) and four latent generative models (Latent Diffusion Model, Latent Diffusion Model+ControlNet, Brownian Bridge, Flow Matching), across eleven datasets spanning three anatomical regions (head/neck, lung, pelvis) and four translation directions (cone-beam CT to CT, MRI to CT, CT to PET, MRI T2-weighted to T2-FLAIR), for a total of 77 experiments under uniform training, inference, and evaluation conditions. The results show that GANs outperform latent generative models across all tasks, with SRGAN achieving statistically significant superiority. Our lesion-level analysis reveals that all models struggle with small lesions and that, in CT to PET synthesis, models reproduce lesion shape more reliably than absolute uptake-related intensity. We also performed a Visual Turing test administered to 17 physicians, including 15 radiologists, which shows near-chance classification accuracy (56.7%), confirming that synthetic volumes are largely indistinguishable from real acquisitions, while exposing a dissociation between quantitative metrics and clinical preference.

Eye tracking has emerged as a powerful tool for examining visual perception and search strategies in various domains, including medicine. While it is relatively straightforward to apply in 2D settings, its use in 3D medical imaging remains challenging and not yet well explored. This gap is particularly relevant for radiology, where volumetric images such as computed tomography (CT) scans are routinely read by medical experts. Radiologists typically interpret these images by navigating through hundreds of 2D slices, most often viewed in the axial projection. A taxonomy of eye movement data during navigation through a CT volume could be valuable to understand how radiologists approach diagnostic tasks. As an example of the derived taxonomy, we asked two radiologists to search abdominal CTs of the pancreas. We collect eye tracking data and align eye gaze movements with slice navigation to visualize the representation of the pancreas through volume and analyze clinicians' gaze behavior in both space and time.

Clinical trial studies indicate benefit of watch-and-wait (WW) surveillance for patients with rectal cancer showing a complete or near clinical response (CR) directly after treatment (restaging). However, there are no objectively accurate methods to early detect local tumor regrowth (LR) in patients undergoing WW from follow-up exams. Hence, we developed Temporal Rectal Endoscopy Cross-attention (TREX), a longitudinal deep learning approach that combines pairs of images acquired at restaging and follow-up to distinguish CR from LR. TREX uses pretrained Swin Transformers in a siamese setting to extract features from longitudinal images and dual cross-attention to combine the features without spatial co-registration between image pairs. TREX and Swin-based baselines were trained under two settings: (a) detecting LR or CR at the last available follow-up and (b) early detection of LR at 3--6, 6--12, and 12--24 months before clinical confirmation. TREX achieved the highest accuracy in detecting LR with a high sensitivity of 97% $\pm$ 6% and a balanced accuracy of 90% $\pm$ 3%, and outperformed all baselines in early detection at both 3--6 (74% $\pm$ 1%) and 6--12 months (62% $\pm$ 4%) prior to clinical detection. Clinical validation via a surgeon survey showed that TREX matched attending-level overall accuracy (TREX: 86.21% vs.\ Clinicians: 87.84% $\pm$ 1.28%). Finally, we explored TREX's ability to predict treatment response by combining pre-treatment (pre-TNT) and restaging endoscopies, achieving a balanced accuracy of 73% $\pm$ 12%. These results show that longitudinal deep learning analysis of endoscopy may improve surveillance and enable earlier identification of rectal cancer regrowth.