The advent of foundation models (FMs) in healthcare offers unprecedented opportunities to enhance medical diagnostics through automated classification and segmentation tasks. However, these models also raise significant concerns about their fairness, especially when applied to diverse and underrepresented populations in healthcare applications. Currently, there is a lack of comprehensive benchmarks, standardized pipelines, and easily adaptable libraries to evaluate and understand the fairness performance of FMs in medical imaging, leading to considerable challenges in formulating and implementing solutions that ensure equitable outcomes across diverse patient populations. To fill this gap, we introduce FairMedFM, a fairness benchmark for FM research in medical imaging.

Recent approaches to vision-language tasks are built on the remarkable capabilities of large vision-language models (VLMs). These models excel in zero-shot and few-shot learning, enabling them to learn new tasks without parameter updates. However, their primary challenge lies in their design, which primarily accommodates 2D input, thus limiting their effectiveness for medical images, particularly radiological images like MRI and CT, which are typically 3D. To bridge the gap between state-of-the-art 2D VLMs and 3D medical image data, we developed an innovative, one-pass, unsupervised representative slice selection method called Vote-MI, which selects representative 2D slices from 3D medical imaging. To evaluate the effectiveness of vote-MI when implemented with VLMs, we introduce BrainMD, a robust, multimodal dataset comprising 2,453 annotated 3D MRI brain scans with corresponding textual radiology reports and electronic health records.

Deep learning has seen remarkable advancements in machine learning, yet it often demands extensive annotated data. Tasks like 3D semantic segmentation impose a substantial annotation burden, especially in domains like medicine, where expert annotations drive up the cost. Active learning (AL) holds great potential to alleviate this annotation burden in 3D medical segmentation. The majority of existing AL methods, however, are not tailored to the medical domain. While weakly-supervised methods have been explored to reduce annotation burden, the fusion of AL with weak supervision remains unexplored, despite its potential to significantly reduce annotation costs.

Transfer learning from natural image datasets, particularly ImageNet, using standard large models and corresponding pretrained weights has become a de-facto method for deep learning applications to medical imaging. However, there are fundamental differences in data sizes, features and task specifications between natural image classification and the target medical tasks, and there is little understanding of the effects of transfer. In this paper, we explore properties of transfer learning for medical imaging. A performance evaluation on two large scale medical imaging tasks shows that surprisingly, transfer offers little benefit to performance, and simple, lightweight models can perform comparably to ImageNet architectures. Investigating the learned representations and features, we find that some of the differences from transfer learning are due to the over-parametrization of standard models rather than sophisticated feature reuse. We isolate where useful feature reuse occurs, and outline the implications for more efficient model exploration. We also explore feature independent benefits of transfer arising from weight scalings.

Medical phrase grounding (MPG) maps textual descriptions of radiological findings to corresponding image regions. These grounded reports are easier to interpret, especially for non-experts. Existing MPG systems mostly follow the referring expression comprehension (REC) paradigm and return exactly one bounding box per phrase. Real reports often violate this assumption. They contain multi-region findings, non-diagnostic text, and non-groundable phrases, such as negations or descriptions of normal anatomy. Motivated by this, we reformulate the task as generalised medical phrase grounding (GMPG), where each sentence is mapped to zero, one, or multiple scored regions. To realise this formulation, we introduce the first GMPG model: MedGrounder. We adopted a two-stage training regime: pre-training on report sentence--anatomy box alignment datasets and fine-tuning on report sentence--human annotated box datasets. Experiments on PadChest-GR and MS-CXR show that MedGrounder achieves strong zero-shot transfer and outperforms REC-style and grounded report generation baselines on multi-region and non-groundable phrases, while using far fewer human box annotations. Finally, we show that MedGrounder can be composed with existing report generators to produce grounded reports without retraining the generator.

Deep learning models for medical image segmentation suffer significant performance drops due to distribution shifts, but the causal mechanisms behind these drops remain poorly understood. We extend causal attribution frameworks to high-dimensional segmentation tasks, quantifying how acquisition protocols and annotation variability independently contribute to performance degradation. We model the data-generating process through a causal graph and employ Shapley values to fairly attribute performance changes to individual mechanisms. Our framework addresses unique challenges in medical imaging: high-dimensional outputs, limited samples, and complex mechanism interactions. Validation on multiple sclerosis (MS) lesion segmentation across 4 centers and 7 annotators reveals context-dependent failure modes: annotation protocol shifts dominate when crossing annotators (7.4% $\pm$ 8.9% DSC attribution), while acquisition shifts dominate when crossing imaging centers (6.5% $\pm$ 9.1%). This mechanism-specific quantification enables practitioners to prioritize targeted interventions based on deployment context.

However, in infants and young children, accurate segmentation is challenging due to development and imaging constraints. Pediatric brain MRI is notoriously difficult to acquire, with inconsistent availability of imaging modalities, substantial non-head anatomy in the field of view, and frequent motion artifacts. This has led to specialized segmentation models that are often limited to specific image types or narrow age groups, or that are fragile for more variable images such as those acquired clinically. We address this method fragmentation with BabySeg, a deep learning brain segmentation framework for infants and young children that supports diverse MRI protocols, including repeat scans and image types unavailable during training. Our approach builds on recent domain randomization techniques, which synthesize training images far beyond realistic bounds to promote dataset shift invariance. We also describe a mechanism that enables models to flexibly pool and interact features from any number of input scans. We demonstrate state-of-the-art performance that matches or exceeds the accuracy of several existing methods for various age cohorts and input configurations using a single model, in a fraction of the runtime required by many existing tools.

Existing foundation models (FMs) in the medical domain often require extensive fine-tuning or rely on training resource-intensive decoders, while many existing encoders are pretrained with objectives biased toward specific tasks. This illustrates a need for a strong, task-agnostic foundation model that requires minimal fine-tuning beyond feature extraction. In this work, we introduce a suite of task-agnostic pretraining of CT foundation models (TAP-CT): a simple yet effective adaptation of Vision Transformers (ViTs) and DINOv2 for volumetric data, enabling scalable self-supervised pretraining directly on 3D CT volumes. Our approach incorporates targeted modifications to patch embeddings, positional encodings, and volumetric augmentations, making the architecture depth-aware while preserving the simplicity of the underlying architectures. We show that large-scale 3D pretraining on an extensive in-house CT dataset (105K volumes) yields stable, robust frozen representations that generalize strongly across downstream tasks. To promote transparency and reproducibility, and to establish a powerful, low-resource baseline for future research in medical imaging, we will release all pretrained models, experimental configurations, and downstream benchmark code at https://huggingface.co/fomofo/tap-ct-b-3d.

Medical imaging is essential for clinical diagnosis, yet real-world data frequently suffers from corruption, noise, and potential tampering, challenging the reliability of AI-assisted interpretation. Conventional reconstruction techniques prioritize pixel-level recovery and may produce visually plausible outputs while compromising anatomical fidelity, an issue that can directly impact clinical outcomes. We propose a semantic-aware medical image reconstruction framework that integrates high-level latent embeddings with a hybrid U-Net architecture to preserve clinically relevant structures during restoration. To ensure trust and accountability, we incorporate a lightweight blockchain-based provenance layer using scale-free graph design, enabling verifiable recording of each reconstruction event without imposing significant overhead. Extensive evaluation across multiple datasets and corruption types demonstrates improved structural consistency, restoration accuracy, and provenance integrity compared with existing approaches. By uniting semantic-guided reconstruction with secure traceability, our solution advances dependable AI for medical imaging, enhancing both diagnostic confidence and regulatory compliance in healthcare environments.