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Sparse Spectral LoRA: Routed Experts for Medical VLMs
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Large vision-language models (VLMs) excel on general benchmarks but often lack robustness in medical imaging, where heterogeneous supervision induces cross-dataset interference and sensitivity to data regime (i.e., how the supervisory signals are mixed). In realistic clinical workflows, data and tasks arrive sequentially, so naive continual training further leads to catastrophic forgetting. To address these challenges, we propose MedQwen, a parameter-efficient medical VLM that couples a spectrally routed Mixture-of-Experts (MoE) with a theoretically grounded scaling rule that aligns low-rank updates with a full-rank, fully fine-tuned MoE, without changing the base architecture. Concretely, we initialize each expert from non-overlapping singular value decomposition (SVD) segments of the pretrained weight and introduce a residual compensation and scaling scheme to enable stable expert specialization and consistent routing under distribution shift. Across 23 medical datasets covering visual question answering, report generation, radiology classification, and hallucination mitigation, MedQwen achieves strong, reliable performance: it approaches full fine-tuning on zero-shot classification with 339$\times$ fewer trainable parameters, and reduces sequential forgetting to $\sim$5\% where strong baselines degrade by $>$20-50\%.
Foundation Model-guided Iteratively Prompting and Pseudo-Labeling for Partially Labeled Medical Image Segmentation
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Automated medical image segmentation has achieved remarkable progress with fully labeled data. However, site-specific clinical priorities and the high cost of manual annotation often yield scans with only a subset of organs labeled, leading to the partially labeled problem that degrades performance. To address this issue, we propose IPnP, an Iteratively Prompting and Pseudo-labeling framework, for partially labeled medical image segmentation. IPnP iteratively generates and refines pseudo-labels for unlabeled organs through collaboration between a trainable segmentation network (specialist) and a frozen foundation model (generalist), progressively recovering full-organ supervision. On the public dataset AMOS with the simulated partial-label setting, IPnP consistently improves segmentation performance over prior methods and approaches the performance of the fully labeled reference. We further evaluate on a private, partially labeled dataset of 210 head-and-neck cancer patients and demonstrate our effectiveness in real-world clinical settings.
Maximizing T2-Only Prostate Cancer Localization from Expected Diffusion Weighted Imaging
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Multiparametric MRI is increasingly recommended as a first-line noninvasive approach to detect and localize prostate cancer, requiring at minimum diffusion-weighted (DWI) and T2-weighted (T2w) MR sequences. Early machine learning attempts using only T2w images have shown promising diagnostic performance in segmenting radiologist-annotated lesions. Such uni-modal T2-only approaches deliver substantial clinical benefits by reducing costs and expertise required to acquire other sequences. This work investigates an arguably more challenging application using only T2w at inference, but to localize individual cancers based on independent histopathology labels. We formulate DWI images as a latent modality (readily available during training) to classify cancer presence at local Barzell zones, given only T2w images as input. In the resulting expectation-maximization algorithm, a latent modality generator (implemented using a flow matching-based generative model) approximates the latent DWI image posterior distribution in the E-steps, while in M-steps a cancer localizer is simultaneously optimized with the generative model to maximize the expected likelihood of cancer presence. The proposed approach provides a novel theoretical framework for learning from a privileged DWI modality, yielding superior cancer localization performance compared to approaches that lack training DWI images or existing frameworks for privileged learning and incomplete modalities. The proposed T2-only methods perform competitively or better than baseline methods using multiple input sequences (e.g., improving the patient-level F1 score by 14.4\% and zone-level QWK by 5.3\% over the T2w+DWI baseline). We present quantitative evaluations using internal and external datasets from 4,133 prostate cancer patients with histopathology-verified labels.
OkanNet: A Lightweight Deep Learning Architecture for Classification of Brain Tumor from MRI Images
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Medical imaging techniques, especially Magnetic Resonance Imaging (MRI), are accepted as the gold standard in the diagnosis and treatment planning of neurological diseases. However, the manual analysis of MRI images is a time-consuming process for radiologists and is prone to human error due to fatigue. In this study, two different Deep Learning approaches were developed and analyzed comparatively for the automatic detection and classification of brain tumors (Glioma, Meningioma, Pituitary, and No Tumor). In the first approach, a custom Convolutional Neural Network (CNN) architecture named "OkanNet", which has a low computational cost and fast training time, was designed from scratch. In the second approach, the Transfer Learning method was applied using the 50-layer ResNet-50 [1] architecture, pre-trained on the ImageNet dataset. In experiments conducted on an extended dataset compiled by Masoud Nickparvar containing a total of $7,023$ MRI images, the Transfer Learning-based ResNet-50 model exhibited superior classification performance, achieving $96.49\%$ Accuracy and $0.963$ Precision. In contrast, the custom OkanNet architecture reached an accuracy rate of $88.10\%$; however, it proved to be a strong alternative for mobile and embedded systems with limited computational power by yielding results approximately $3.2$ times faster ($311$ seconds) than ResNet-50 in terms of training time. This study demonstrates the trade-off between model depth and computational efficiency in medical image analysis through experimental data.
BioCOMPASS: Integrating Biomarkers into Transformer-Based Immunotherapy Response Prediction
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Datasets used in immunotherapy response prediction are typically small in size, as well as diverse in cancer type, drug administered, and sequencer used. Models often drop in performance when tested on patient cohorts that are not included in the training process. Recent work has shown that transformer-based models along with self-supervised learning show better generalisation performance than threshold-based biomarkers, but is still suboptimal. We present BioCOMPASS, an extension of a transformer-based model called COMPASS, that integrates biomarkers and treatment information to further improve its generalisability. Instead of feeding biomarker data as input, we built loss components to align them with the model's intermediate representations. We found that components such as treatment gating and pathway consistency loss improved generalisability when evaluated with Leave-one-cohort-out, Leave-one-cancer-type-out and Leave-one-treatment-out strategies. Results show that building components that exploit biomarker and treatment information can help in generalisability of immunotherapy response prediction. Careful curation of additional components that leverage complementary clinical information and domain knowledge represents a promising direction for future research.
Quantifying Cross-Modal Interactions in Multimodal Glioma Survival Prediction via InterSHAP: Evidence for Additive Signal Integration
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Multimodal deep learning for cancer prognosis is commonly assumed to benefit from synergistic cross-modal interactions, yet this assumption has not been directly tested in survival prediction settings. This work adapts InterSHAP, a Shapley interaction index-based metric, from classification to Cox proportional hazards models and applies it to quantify cross-modal interactions in glioma survival prediction. Using TCGA-GBM and TCGA-LGG data (n=575), we evaluate four fusion architectures combining whole-slide image (WSI) and RNA-seq features. Our central finding is an inverse relationship between predictive performance and measured interaction: architectures achieving superior discrimination (C-index 0.64$\to$0.82) exhibit equivalent or lower cross-modal interaction (4.8\%$\to$3.0\%). Variance decomposition reveals stable additive contributions across all architectures (WSI${\approx}$40\%, RNA${\approx}$55\%, Interaction${\approx}$4\%), indicating that performance gains arise from complementary signal aggregation rather than learned synergy. These findings provide a practical model auditing tool for comparing fusion strategies, reframe the role of architectural complexity in multimodal fusion, and have implications for privacy-preserving federated deployment.
Trimodal Deep Learning for Glioma Survival Prediction: A Feasibility Study Integrating Histopathology, Gene Expression, and MRI
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Multimodal deep learning has improved prognostic accuracy for brain tumours by integrating histopathology and genomic data, yet the contribution of volumetric MRI within unified survival frameworks remains unexplored. This pilot study extends a bimodal framework by incorporating Fluid Attenuated Inversion Recovery (FLAIR) MRI from BraTS2021 as a third modality. Using the TCGA-GBMLGG cohort (664 patients), we evaluate three unimodal models, nine bimodal configurations, and three trimodal configurations across early, late, and joint fusion strategies. In this small cohort setting, trimodal early fusion achieves an exploratory Composite Score (CS = 0.854), with a controlled $Δ$CS of +0.011 over the bimodal baseline on identical patients, though this difference is not statistically significant (p = 0.250, permutation test). MRI achieves reasonable unimodal discrimination (CS = 0.755) but does not substantially improve bimodal pairs, while providing measurable uplift in the three-way combination. All MRI containing experiments are constrained to 19 test patients, yielding wide bootstrap confidence intervals (e.g. [0.400,1.000]) that preclude definitive conclusions. These findings provide preliminary evidence that a third imaging modality may add prognostic value even with limited sample sizes, and that additional modalities require sufficient multimodal context to contribute effectively.
Diffusion-Based Feature Denoising with NNMF for Robust handwritten digit multi-class classification
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This work presents a robust multi-class classification framework for handwritten digits that combines diffusion-driven feature denoising with a hybrid feature representation. Inspired by our previous work on brain tumor classification, the proposed approach operates in a feature space to improve the robustness to noise and adversarial attacks. First, the input images are converted into tight, interpretable exemplification using Nonnegative Matrix Factorization (NNMF). In parallel, special deep features are extracted using a computational neural network (CNN). These integral features are combined into a united hybrid representation. To improve robustness, a step diffusion operation is used in the feature space by gradually adding Gaussian noise. A feature denoiser network is trained to reverse this operation and rebuild clean representations from tilted inputs. The courteous features are then applied for multi-class classification. The suggested method is evaluated in both baseline and adversarial settings using AutoAttack. The experimental outcome present that the diffusion-based hybrid model is both effective and robust, the CNN baseline models outperforming while maintain powerful classification performance. These results explain the activity of feature-level diffusion defense for reliable multi-class handwritten digit classification.
Less Is More? Selective Visual Attention to High-Importance Regions for Multimodal Radiology Summarization
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Automated radiology report summarization aims to distill verbose findings into concise clinical impressions, but existing multimodal models often struggle with visual noise and fail to meaningfully improve over strong text-only baselines in the FINDINGS $\to$ IMPRESSION transformation. We challenge two prevailing assumptions: (1) that more visual input is always better, and (2) that multimodal models add limited value when findings already contain rich image-derived detail. Through controlled ablations on MIMIC-CXR benchmark, we show that selectively focusing on pathology-relevant visual patches rather than full images yields substantially better performance. We introduce ViTAS, Visual-Text Attention Summarizer, a multi-stage pipeline that combines ensemble-guided MedSAM2 lung segmentation, bidirectional cross-attention for multi-view fusion, Shapley-guided adaptive patch clustering, and hierarchical visual tokenization feeding a ViT. ViTAS achieves SOTA results with 29.25% BLEU-4 and 69.83% ROUGE-L, improved factual alignment in qualitative analysis, and the highest expert-rated human evaluation scores. Our findings demonstrate that less but more relevant visual input is not only sufficient but superior for multimodal radiology summarization.
Multimodal Machine Learning for Early Prediction of Metastasis in a Swedish Multi-Cancer Cohort
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Multimodal Machine Learning offers a holistic view of a patient's status, integrating structured and unstructured data from electronic health records (EHR). We propose a framework to predict metastasis risk one month prior to diagnosis, using six months of clinical history from EHR data. Data from four cancer cohorts collected at Karolinska University Hospital (Stockholm, Sweden) were analyzed: breast (n = 743), colon (n = 387), lung (n = 870), and prostate (n = 1890). The dataset included demographics, comorbidities, laboratory results, medications, and clinical text. We compared traditional and deep learning classifiers across single modalities and multimodal combinations, using various fusion strategies and a Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) 2a design, with an 80-20 development-validation split to ensure a rigorous, repeatable evaluation. Performance was evaluated using AUROC, AUPRC, F1 score, sensitivity, and specificity. We then employed a multimodal adaptation of SHAP to analyze the classifiers' reasoning. Intermediate fusion achieved the highest F1 scores on breast (0.845), colon (0.786), and prostate cancer (0.845), demonstrating strong predictive performance. For lung cancer, the intermediate fusion achieved an F1 score of 0.819, while the text-only model achieved the highest, with an F1 score of 0.829. Deep learning classifiers consistently outperformed traditional models. Colon cancer, the smallest cohort, had the lowest performance, highlighting the importance of sufficient training data. SHAP analysis showed that the relative importance of modalities varied across cancer types. Fusion strategies offer distinct strengths and weaknesses. Intermediate fusion consistently delivered the best results, but strategy choices should align with data characteristics and organizational needs.