Foundation models hold promise for specialized medical imaging tasks, though their effectiveness in breast imaging remains underexplored. This study leverages BiomedCLIP as a foundation model to address challenges in model generalizations. BiomedCLIP was adapted for automated BI-RADS breast density classification using multi-modality mammographic data (synthesized 2D images, digital mammography, and digital breast tomosyn-thesis). Using 96,995 images, we compared single-modality (s2D only) and multi-modality training approaches, addressing class imbalance through weighted contrastive learning. Both approaches achieved similar accuracy (multi-modality: 0.74, single-modality: 0.73), with the multi-modality model offering broader applicability across different imaging modalities and higher AUC values consistently above 0.84 across BI-RADS categories. External validation on the RSNA and EMBED datasets showed strong generalization capabilities (AUC range: 0.80-0.93). GradCAM visualizations confirmed consistent and clinically relevant attention patterns, highlighting the models' interpretability and robustness. This research underscores the potential of foundation models for breast imaging applications, paving the way for future extensions for diagnostic tasks.

Mammographic breast density is a well-established risk factor for breast cancer. Recently there has been interest in breast MRI as an adjunct to mammography, as this modality provides an orthogonal and highly quantitative assessment of breast tissue. However, its 3D nature poses analytic challenges related to delineating and aggregating complex structures across slices. Here, we applied an in-house machine-learning algorithm to assess breast density on normal breasts in three MRI datasets. Breast density was consistent across different datasets (0.104 - 0.114). Analysis across different age groups also demonstrated strong consistency across datasets and confirmed a trend of decreasing density with age as reported in previous studies. MR breast density was correlated with mammographic breast density, although some notable differences suggest that certain breast density components are captured only on MRI. Future work will determine how to integrate MR breast density with current tools to improve future breast cancer risk prediction.

The development of clinically reliable artificial intelligence (AI) systems for mammography is hindered by profound heterogeneity in data quality, metadata standards, and population distributions across public datasets. This heterogeneity introduces dataset-specific biases that severely compromise the generalizability of the model, a fundamental barrier to clinical deployment. We present MammoClean, a public framework for standardization and bias quantification in mammography datasets. MammoClean standardizes case selection, image processing (including laterality and intensity correction), and unifies metadata into a consistent multi-view structure. We provide a comprehensive review of breast anatomy, imaging characteristics, and public mammography datasets to systematically identify key sources of bias. Applying MammoClean to three heterogeneous datasets (CBIS-DDSM, TOMPEI-CMMD, VinDr-Mammo), we quantify substantial distributional shifts in breast density and abnormality prevalence. Critically, we demonstrate the direct impact of data corruption: AI models trained on corrupted datasets exhibit significant performance degradation compared to their curated counterparts. By using MammoClean to identify and mitigate bias sources, researchers can construct unified multi-dataset training corpora that enable development of robust models with superior cross-domain generalization. MammoClean provides an essential, reproducible pipeline for bias-aware AI development in mammography, facilitating fairer comparisons and advancing the creation of safe, effective systems that perform equitably across diverse patient populations and clinical settings. The open-source code is publicly available from: https://github.com/Minds-R-Lab/MammoClean.

Mammography, the current standard for breast cancer screening, has reduced sensitivity in women with dense breast tissue, contributing to missed or delayed diagnoses. Thermalytix, an AI-based thermal imaging modality, captures functional vascular and metabolic cues that may complement mammographic structural data. This study investigates whether a breast density-informed multi-modal AI framework can improve cancer detection by dynamically selecting the appropriate imaging modality based on breast tissue composition. A total of 324 women underwent both mammography and thermal imaging. Mammography images were analyzed using a multi-view deep learning model, while Thermalytix assessed thermal images through vascular and thermal radiomics. The proposed framework utilized Mammography AI for fatty breasts and Thermalytix AI for dense breasts, optimizing predictions based on tissue type. This multi-modal AI framework achieved a sensitivity of 94.55% (95% CI: 88.54-100) and specificity of 79.93% (95% CI: 75.14-84.71), outperforming standalone mammography AI (sensitivity 81.82%, specificity 86.25%) and Thermalytix AI (sensitivity 92.73%, specificity 75.46%). Importantly, the sensitivity of Mammography dropped significantly in dense breasts (67.86%) versus fatty breasts (96.30%), whereas Thermalytix AI maintained high and consistent sensitivity in both (92.59% and 92.86%, respectively). This demonstrates that a density-informed multi-modal AI framework can overcome key limitations of unimodal screening and deliver high performance across diverse breast compositions. The proposed framework is interpretable, low-cost, and easily deployable, offering a practical path to improving breast cancer screening outcomes in both high-resource and resource-limited settings.

Self-supervised learning (SSL) has transformed vision encoder training in general domains but remains underutilized in medical imaging due to limited data and domain specific biases. We present MammoDINO, a novel SSL framework for mammography, pretrained on 1.4 million mammographic images. To capture clinically meaningful features, we introduce a breast tissue aware data augmentation sampler for both image-level and patch-level supervision and a cross-slice contrastive learning objective that leverages 3D digital breast tomosynthesis (DBT) structure into 2D pretraining. MammoDINO achieves state-of-the-art performance on multiple breast cancer screening tasks and generalizes well across five benchmark datasets. It offers a scalable, annotation-free foundation for multipurpose computer-aided diagnosis (CAD) tools for mammogram, helping reduce radiologists' workload and improve diagnostic efficiency in breast cancer screening.

Mammography screening is an essential tool for early detection of breast cancer. The speed and accuracy of mammography interpretation have the potential to be improved with deep learning methods. However, the development of a foundation visual language model (VLM) is hindered by limited data and domain differences between natural and medical images. Existing mammography VLMs, adapted from natural images, often ignore domain-specific characteristics, such as multi-view relationships in mammography. Unlike radiologists who analyze both views together to process ipsilateral correspondence, current methods treat them as independent images or do not properly model the multi-view correspondence learning, losing critical geometric context and resulting in suboptimal prediction. We propose GLAM: Global and Local Alignment for Multi-view mammography for VLM pretraining using geometry guidance. By leveraging the prior knowledge about the multi-view imaging process of mammograms, our model learns local cross-view alignments and fine-grained local features through joint global and local, visual-visual, and visual-language contrastive learning. Pretrained on EMBED [14], one of the largest open mammography datasets, our model outperforms baselines across multiple datasets under different settings.

Contrast-enhanced spectral mammography (CESM) is an imaging modality that provides two types of images, commonly known as low-energy (LE) and dual-energy subtracted (DES) images. In many domains, particularly in medicine, the emergence of image-to-image translation techniques has enabled the artificial generation of images using other images as input. Within CESM, applying such techniques to generate DES images from LE images could be highly beneficial, potentially reducing patient exposure to radiation associated with high-energy image acquisition. In this study, we investigated three models for the artificial generation of DES images (virtual DES): a pre-trained U-Net model, a U-Net trained end-to-end model, and a CycleGAN model. We also performed a series of experiments to assess the impact of using virtual DES images on the classification of CESM examinations into malignant and non-malignant categories. To our knowledge, this is the first study to evaluate the impact of virtual DES images on CESM lesion classification. The results demonstrate that the best performance was achieved with the pre-trained U-Net model, yielding an F1 score of 85.59% when using the virtual DES images, compared to 90.35% with the real DES images. This discrepancy likely results from the additional diagnostic information in real DES images, which contributes to a higher classification accuracy. Nevertheless, the potential for virtual DES image generation is considerable and future advancements may narrow this performance gap to a level where exclusive reliance on virtual DES images becomes clinically viable.

Early and accurate interpretation of screening mammograms is essential for effective breast cancer detection, yet it remains a complex challenge due to subtle imaging findings and diagnostic ambiguity. Many existing AI approaches fall short by focusing on single view inputs or single-task outputs, limiting their clinical utility. To address these limitations, we propose a novel multi-view, multitask hybrid deep learning framework that processes all four standard mammography views and jointly predicts diagnostic labels and BI-RADS scores for each breast. Our architecture integrates a hybrid CNN VSSM backbone, combining convolutional encoders for rich local feature extraction with Visual State Space Models (VSSMs) to capture global contextual dependencies. To improve robustness and interpretability, we incorporate a gated attention-based fusion module that dynamically weights information across views, effectively handling cases with missing data. We conduct extensive experiments across diagnostic tasks of varying complexity, benchmarking our proposed hybrid models against baseline CNN architectures and VSSM models in both single task and multi task learning settings. Across all tasks, the hybrid models consistently outperform the baselines. In the binary BI-RADS 1 vs. 5 classification task, the shared hybrid model achieves an AUC of 0.9967 and an F1 score of 0.9830. For the more challenging ternary classification, it attains an F1 score of 0.7790, while in the five-class BI-RADS task, the best F1 score reaches 0.4904. These results highlight the effectiveness of the proposed hybrid framework and underscore both the potential and limitations of multitask learning for improving diagnostic performance and enabling clinically meaningful mammography analysis.

--Mammographic breast density classification is essential for cancer risk assessment but remains challenging due to subjective interpretation and inter-observer variability. This study compares multimodal and CNN-based methods for automated classification using the BI-RADS system, evaluating BioMedCLIP and ConvNeXt across three learning scenarios: zero-shot classification, linear probing with textual descriptions, and fine-tuning with numerical labels. Results show that zero-shot classification achieved modest performance, while the fine-tuned ConvNeXt model outperformed the BioMedCLIP linear probe. Although linear probing demonstrated potential with pretrained embeddings, it was less effective than full fine-tuning. These findings suggest that despite the promise of multimodal learning, CNN-based models with end-to-end fine-tuning provide stronger performance for specialized medical imaging. The study underscores the need for more detailed textual representations and domain-specific adaptations in future radiology applications. Accurate breast density classification plays a critical role in assessing breast cancer risk.

This study presents a deep learning system for breast cancer detection in mammography, developed using a modified EfficientNetV2 architecture with enhanced attention mechanisms. The model was trained on mammograms from a major Thai medical center and validated on three distinct datasets: an in-domain test set (9,421 cases), a biopsy-confirmed set (883 cases), and an out-of-domain generalizability set (761 cases) collected from two different hospitals. For cancer detection, the model achieved AUROCs of 0.89, 0.96, and 0.94 on the respective datasets. The system's lesion localization capability, evaluated using metrics including Lesion Localization Fraction (LLF) and Non-Lesion Localization Fraction (NLF), demonstrated robust performance in identifying suspicious regions. Clinical validation through concordance tests showed strong agreement with radiologists: 83.5% classification and 84.0% localization concordance for biopsy-confirmed cases, and 78.1% classification and 79.6% localization concordance for out-of-domain cases. Expert radiologists' acceptance rate also averaged 96.7% for biopsy-confirmed cases, and 89.3% for out-of-domain cases. The system achieved a System Usability Scale score of 74.17 for source hospital, and 69.20 for validation hospitals, indicating good clinical acceptance. These results demonstrate the model's effectiveness in assisting mammogram interpretation, with the potential to enhance breast cancer screening workflows in clinical practice.