The increasing prevalence of thyroid cancer globally has led to the development of various computer-aided detection methods. Accurate segmentation of thyroid nodules is a critical first step in the development of AI-assisted clinical decision support systems. This study focuses on instance segmentation of thyroid nodules using YOLOv5 algorithms on ultrasound images. We evaluated multiple YOLOv5 variants (Nano, Small, Medium, Large, and XLarge) across two dataset versions, with and without doppler images. The YOLOv5-Large algorithm achieved the highest performance with a dice score of 91\% and mAP of 0.87 on the dataset including doppler images. Notably, our results demonstrate that doppler images, typically excluded by physicians, can significantly improve segmentation performance. The YOLOv5-Small model achieved 79\% dice score when doppler images were excluded, while including them improved performance across all model variants. These findings suggest that instance segmentation with YOLOv5 provides an effective real-time approach for thyroid nodule detection, with potential clinical applications in automated diagnostic systems.

Ultrasound-based risk stratification of thyroid nodules is a critical clinical task, but it suffers from high inter-observer variability. While many deep learning (DL) models function as "black boxes," we propose a fully automated, two-stage framework for interpretable malignancy prediction. Our method achieves interpretability by forcing the model to focus only on clinically relevant regions. First, a TransUNet model automatically segments the thyroid nodule. The resulting mask is then used to create a region of interest around the nodule, and this localised image is fed directly into a ResNet-18 classifier. We evaluated our framework using 5-fold cross-validation on a clinical dataset of 349 images, where it achieved a high F1-score of 0.852 for predicting malignancy. To validate its performance, we compared it against a strong baseline using a Random Forest classifier with hand-crafted morphological features, which achieved an F1-score of 0.829. The superior performance of our DL framework suggests that the implicit visual features learned from the localised nodule are more predictive than explicit shape features alone. This is the first fully automated end-to-end pipeline for both detecting thyroid nodules on ultrasound images and predicting their malignancy.

We introduce CoDe-KG, an open-source, end-to-end pipeline for extracting sentence-level knowledge graphs by combining robust coreference resolution with syntactic sentence decomposition. Using our model, we contribute a dataset of over 150,000 knowledge triples, which is open source. We also contribute a training corpus of 7248 rows for sentence complexity, 190 rows of gold human annotations for co-reference resolution using open source lung-cancer abstracts from PubMed, 900 rows of gold human annotations for sentence conversion policies, and 398 triples of gold human annotations. We systematically select optimal prompt-model pairs across five complexity categories, showing that hybrid chain-of-thought and few-shot prompting yields up to 99.8% exact-match accuracy on sentence simplification. On relation extraction (RE), our pipeline achieves 65.8% macro-F1 on REBEL, an 8-point gain over the prior state of the art, and 75.7% micro-F1 on WebNLG2, while matching or exceeding performance on Wiki-NRE and CaRB. Ablation studies demonstrate that integrating coreference and decomposition increases recall on rare relations by over 20%. Code and dataset are available at https://github.com/KaushikMahmud/CoDe-KG_EMNLP_2025

Machine learning models have utilized semantic features, deep features, or both to assess lung nodule malignancy. However, their reliance on manual annotation during inference, limited interpretability, and sensitivity to imaging variations hinder their application in real-world clinical settings. Thus, this research aims to integrate semantic features derived from radiologists' assessments of nodules, guiding the model to learn clinically relevant, robust, and explainable imaging features for predicting lung cancer. We obtained 938 low-dose CT scans from the National Lung Screening Trial (NLST) with 1,261 nodules and semantic features. Additionally, the Lung Image Database Consortium dataset contains 1,018 CT scans, with 2,625 lesions annotated for nodule characteristics. Three external datasets were obtained from UCLA Health, the LUNGx Challenge, and the Duke Lung Cancer Screening. We fine-tuned a pretrained Contrastive Language-Image Pretraining (CLIP) model with a parameter-efficient fine-tuning approach to align imaging and semantic text features and predict the one-year lung cancer diagnosis. Our model outperformed state-of-the-art (SOTA) models in the NLST test set with an AUROC of 0.901 and AUPRC of 0.776. It also showed robust results in external datasets. Using CLIP, we also obtained predictions on semantic features through zero-shot inference, such as nodule margin (AUROC: 0.807), nodule consistency (0.812), and pleural attachment (0.840). Our approach surpasses the SOTA models in predicting lung cancer across datasets collected from diverse clinical settings, providing explainable outputs, aiding clinicians in comprehending the underlying meaning of model predictions. This approach also prevents the model from learning shortcuts and generalizes across clinical settings. The code is available at https://github.com/luotingzhuang/CLIP_nodule.

Accurate segmentation of nodules in both 2D breast ultrasound (BUS) and 3D automated breast ultrasound (ABUS) is crucial for clinical diagnosis and treatment planning. Therefore, developing an automated system for nodule segmentation can enhance user independence and expedite clinical analysis. Unlike fully-supervised learning, weakly-supervised segmentation (WSS) can streamline the laborious and intricate annotation process. However, current WSS methods face challenges in achieving precise nodule segmentation, as many of them depend on inaccurate activation maps or inefficient pseudo-mask generation algorithms. In this study, we introduce a novel multi-agent reinforcement learning-based WSS framework called Flip Learning, which relies solely on 2D/3D boxes for accurate segmentation. Specifically, multiple agents are employed to erase the target from the box to facilitate classification tag flipping, with the erased region serving as the predicted segmentation mask. The key contributions of this research are as follows: (1) Adoption of a superpixel/supervoxel-based approach to encode the standardized environment, capturing boundary priors and expediting the learning process. (2) Introduction of three meticulously designed rewards, comprising a classification score reward and two intensity distribution rewards, to steer the agents' erasing process precisely, thereby avoiding both under- and over-segmentation. (3) Implementation of a progressive curriculum learning strategy to enable agents to interact with the environment in a progressively challenging manner, thereby enhancing learning efficiency. Extensively validated on the large in-house BUS and ABUS datasets, our Flip Learning method outperforms state-of-the-art WSS methods and foundation models, and achieves comparable performance as fully-supervised learning algorithms.

Lung nodule detection in chest CT is crucial for early lung cancer diagnosis, yet existing deep learning approaches face challenges when deployed in clinical settings with limited annotated data. While curriculum learning has shown promise in improving model training, traditional static curriculum strategies fail in data-scarce scenarios. We propose Scale Adaptive Curriculum Learning (SACL), a novel training strategy that dynamically adjusts curriculum design based on available data scale. SACL introduces three key mechanisms:(1) adaptive epoch scheduling, (2) hard sample injection, and (3) scale-aware optimization. We evaluate SACL on the LUNA25 dataset using YOLOv11 as the base detector. Experimental results demonstrate that while SACL achieves comparable performance to static curriculum learning on the full dataset in mAP50, it shows significant advantages under data-limited conditions with 4.6%, 3.5%, and 2.0% improvements over baseline at 10%, 20%, and 50% of training data respectively. By enabling robust training across varying data scales without architectural modifications, SACL provides a practical solution for healthcare institutions to develop effective lung nodule detection systems despite limited annotation resources.

The development of multimodal models for pulmonary nodule diagnosis is limited by the scarcity of labeled data and the tendency for these models to overfit on the training distribution. In this work, we leverage self-supervised learning from longitudinal and multimodal archives to address these challenges. We curate an unlabeled set of patients with CT scans and linked electronic health records from our home institution to power joint embedding predictive architecture (JEPA) pretraining. After supervised finetuning, we show that our approach outperforms an unregularized multimodal model and imaging-only model in an internal cohort (ours: 0.91, multimodal: 0.88, imaging-only: 0.73 AUC), but underperforms in an external cohort (ours: 0.72, imaging-only: 0.75 AUC). We develop a synthetic environment that characterizes the context in which JEPA may underperform. This work innovates an approach that leverages unlabeled multimodal medical archives to improve predictive models and demonstrates its advantages and limitations in pulmonary nodule diagnosis.

Objective: Lung cancer is a leading cause of cancer-related mortality worldwide, primarily due to delayed diagnosis and poor early detection. This study aims to develop a computer-aided diagnosis (CAD) system that leverages large vision-language models (VLMs) for the accurate detection and classification of pulmonary nodules in computed tomography (CT) scans. Methods: We propose an end-to-end CAD pipeline consisting of two modules: (i) a detection module (CADe) based on the Segment Anything Model 2 (SAM2), in which the standard visual prompt is replaced with a text prompt encoded by CLIP (Contrastive Language-Image Pretraining), and (ii) a diagnosis module (CADx) that calculates similarity scores between segmented nodules and radiomic features. To add clinical context, synthetic electronic medical records (EMRs) were generated using radiomic assessments by expert radiologists and combined with similarity scores for final classification. The method was tested on the publicly available LIDC-IDRI dataset (1,018 CT scans). Results: The proposed approach demonstrated strong performance in zero-shot lung nodule analysis. The CADe module achieved a Dice score of 0.92 and an IoU of 0.85 for nodule segmentation. The CADx module attained a specificity of 0.97 for malignancy classification, surpassing existing fully supervised methods. Conclusions: The integration of VLMs with radiomics and synthetic EMRs allows for accurate and clinically relevant CAD of pulmonary nodules in CT scans. The proposed system shows strong potential to enhance early lung cancer detection, increase diagnostic confidence, and improve patient management in routine clinical workflows.

--Dermatological care via telemedicine often lacks the rich context of in-person visits. Clinicians must make diagnoses based on a handful of images and brief descriptions, without the benefit of physical exams, second opinions, or reference materials. While many medical AI systems attempt to bridge these gaps with domain-specific fine-tuning, this work hypothesized that mimicking clinical reasoning processes could offer a more effective path forward. This study tested seven vision-language models on medical visual question answering across six configurations: baseline models, fine-tuned variants, and both augmented with either reasoning layers that combine multiple model perspectives, analogous to peer consultation, or retrieval-augmented generation that incorporates medical literature at inference time, serving a role similar to reference-checking. While fine-tuning degraded performance in four of seven models with an average 30% decrease, baseline models collapsed on test data. Clinical-inspired architectures, meanwhile, achieved up to 70% accuracy, maintaining performance on unseen data while generating explainable, literature-grounded outputs critical for clinical adoption. These findings demonstrate that medical AI succeeds by reconstructing the collaborative and evidence-based practices fundamental to clinical diagnosis. Fine-tuning large models on medical data, the standard approach to medical AI, assumes domain exposure produces clinical competence [1]. Y et dermatology models show 15% performance drops in real-world settings [2], and catastrophic forgetting causes models to generate outputs exclusively from their training data [3]. This brittleness suggests a fundamental mismatch between current approaches and clinical reasoning. Additionally, physician groups achieve 85.6% diagnostic accuracy versus 62.5% for individuals [4], as collaboration reduces cognitive load and bias [5]. However, logistical constraints force physicians to work alone, a problem telemedicine intensifies by eliminating physical exams, peer consultation, and immediate reference access [6].

Thyroid cancer is among the most common cancers in the United States. Thyroid nodules are frequently detected through ultrasound (US) imaging, and some require further evaluation via fine-needle aspiration (FNA) biopsy. Despite its effectiveness, FNA often leads to unnecessary biopsies of benign nodules, causing patient discomfort and anxiety. To address this, the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) has been developed to reduce benign biopsies. However, such systems are limited by interobserver variability. Recent deep learning approaches have sought to improve risk stratification, but they often fail to utilize the rich temporal and spatial context provided by US cine clips, which contain dynamic global information and surrounding structural changes across various views. In this work, we propose the Spatio-Temporal Cross Attention for Cine Thyroid Ultrasound Time Series Classification (STACT-Time) model, a novel representation learning framework that integrates imaging features from US cine clips with features from segmentation masks automatically generated by a pretrained model. By leveraging self-attention and cross-attention mechanisms, our model captures the rich temporal and spatial context of US cine clips while enhancing feature representation through segmentation-guided learning. Our model improves malignancy prediction compared to state-of-the-art models, achieving a cross-validation precision of 0.91 (plus or minus 0.02) and an F1 score of 0.89 (plus or minus 0.02). By reducing unnecessary biopsies of benign nodules while maintaining high sensitivity for malignancy detection, our model has the potential to enhance clinical decision-making and improve patient outcomes.