--We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMulti-Points, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Medical imaging comes with numerous challenges, such as detecting subtle abnormalities, processing images captured under varied conditions, and managing high data volumes, all of which complicate automated analysis [1].

W e propose DiffAug a novel framework that combines text-guided diffusion-based generation with automatic segmentation validation to address this challenge. Our proposed approach uses latent diffusion models conditioned on medical text descriptions and spatial masks to synthesize abnormalities via inpainting on normal images. Generated samples undergo dynamic quality validation through a latent-space segmentation network that ensures accurate localization while enabling single-step inference. The text prompts, derived from medical literature, guide the generation of diverse abnormality types without requiring manual annotation. Our validation mechanism filters synthetic samples based on spatial accuracy, maintaining quality while operating efficiently through direct latent estimation. Evaluated on three medical imaging benchmarks (CVC-ClinicDB, Kvasir-SEG, REFUGE2), our framework achieves state-of-the-art performance with 8-10% Dice improvements over baselines and reduces false negative rates by up to 28% for challenging cases like small polyps and flat lesions critical for early detection in screening applications.

Automated polyp counting in colonoscopy is a crucial step toward automated procedure reporting and quality control, aiming to enhance the cost-effectiveness of colonoscopy screening. Counting polyps in a procedure involves detecting and tracking polyps, and then clustering tracklets that belong to the same polyp entity. Existing methods for polyp counting rely on self-supervised learning and primarily leverage visual appearance, neglecting temporal relationships in both tracklet feature learning and clustering stages. In this work, we introduce a paradigm shift by proposing a supervised contrastive loss that incorporates temporally-aware soft targets. Our approach captures intra-polyp variability while preserving inter-polyp discriminability, leading to more robust clustering. Additionally, we improve tracklet clustering by integrating a temporal adjacency constraint, reducing false positive re-associations between visually similar but temporally distant tracklets. We train and validate our method on publicly available datasets and evaluate its performance with a leave-one-out cross-validation strategy. Results demonstrate a 2.2x reduction in fragmentation rate compared to prior approaches. Our results highlight the importance of temporal awareness in polyp counting, establishing a new state-of-the-art. Code is available at https://github.com/lparolari/temporally-aware-polyp-counting.

Pre-training on image-text colonoscopy records offers substantial potential for improving endoscopic image analysis, but faces challenges including non-informative background images, complex medical terminology, and ambiguous multi-lesion descriptions. We introduce Endo-CLIP, a novel self-supervised framework that enhances Contrastive Language-Image Pre-training (CLIP) for this domain. Endo-CLIP's three-stage framework--cleansing, attunement, and unification--addresses these challenges by: (1) removing background frames, (2) leveraging large language models (LLMs) to extract clinical attributes for fine-grained contrastive learning, and (3) employing patient-level cross-attention to resolve multi-polyp ambiguities. Extensive experiments demonstrate that Endo-CLIP significantly outperforms state-of-the-art pre-training methods in zero-shot and few-shot polyp detection and classification, paving the way for more accurate and clinically relevant endoscopic analysis. Code will be made publicly available on https://github.com/chrlott/

Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths and the third most prevalent malignant tumour worldwide. Early detection of CRC remains problematic due to its non-specific and often embarrassing symptoms, which patients frequently overlook or hesitate to report to clinicians. Crucially, the stage at which CRC is diagnosed significantly impacts survivability, with a survival rate of 80-95\% for Stage I and a stark decline to 10\% for Stage IV. Unfortunately, in the UK, only 14.4\% of cases are diagnosed at the earliest stage (Stage I). In this study, we propose ColonScopeX, a machine learning framework utilizing explainable AI (XAI) methodologies to enhance the early detection of CRC and pre-cancerous lesions. Our approach employs a multimodal model that integrates signals from blood sample measurements, processed using the Savitzky-Golay algorithm for fingerprint smoothing, alongside comprehensive patient metadata, including medication history, comorbidities, age, weight, and BMI. By leveraging XAI techniques, we aim to render the model's decision-making process transparent and interpretable, thereby fostering greater trust and understanding in its predictions. The proposed framework could be utilised as a triage tool or a screening tool of the general population. This research highlights the potential of combining diverse patient data sources and explainable machine learning to tackle critical challenges in medical diagnostics.

Early detection, accurate segmentation, classification and tracking of polyps during colonoscopy are critical for preventing colorectal cancer. Many existing deep-learning-based methods for analyzing colonoscopic videos either require task-specific fine-tuning, lack tracking capabilities, or rely on domain-specific pre-training. In this paper, we introduce PolypSegTrack, a novel foundation model that jointly addresses polyp detection, segmentation, classification and unsupervised tracking in colonoscopic videos. Our approach leverages a novel conditional mask loss, enabling flexible training across datasets with either pixel-level segmentation masks or bounding box annotations, allowing us to bypass task-specific fine-tuning. Our unsupervised tracking module reliably associates polyp instances across frames using object queries, without relying on any heuristics. We leverage a robust vision foundation model backbone that is pre-trained unsupervisedly on natural images, thereby removing the need for domain-specific pre-training. Extensive experiments on multiple polyp benchmarks demonstrate that our method significantly outperforms existing state-of-the-art approaches in detection, segmentation, classification, and tracking.

While AI-assisted colonoscopy promises improved colorectal cancer screening, its success relies on effective integration into clinical practice, not just algorithmic accuracy. This paper, based on an Australian field study (observations and gastroenterologist interviews), highlights a critical disconnect: current development prioritizes machine learning model performance, overlooking essential aspects of user interface design, workflow integration, and overall user experience. Industry interactions reveal a similar emphasis on data and algorithms. To realize AI's full potential, the HCI community must champion user-centered design, ensuring these systems are usable, support endoscopist expertise, and enhance patient outcomes.

Colorectal cancer (CRC) is a significant global health concern, and early detection through screening plays a critical role in reducing mortality. While deep learning models have shown promise in improving polyp detection, classification, and segmentation, their generalization across diverse clinical environments, particularly with out-of-distribution (OOD) data, remains a challenge. Multi-center datasets like PolypGen have been developed to address these issues, but their collection is costly and time-consuming. Traditional data augmentation techniques provide limited variability, failing to capture the complexity of medical images. Diffusion models have emerged as a promising solution for generating synthetic polyp images, but the image generation process in current models mainly relies on segmentation masks as the condition, limiting their ability to capture the full clinical context. To overcome these limitations, we propose a Progressive Spectrum Diffusion Model (PSDM) that integrates diverse clinical annotations-such as segmentation masks, bounding boxes, and colonoscopy reports-by transforming them into compositional prompts. These prompts are organized into coarse and fine components, allowing the model to capture both broad spatial structures and fine details, generating clinically accurate synthetic images. By augmenting training data with PSDM-generated samples, our model significantly improves polyp detection, classification, and segmentation. For instance, on the PolypGen dataset, PSDM increases the F1 score by 2.12% and the mean average precision by 3.09%, demonstrating superior performance in OOD scenarios and enhanced generalization.

Deep learning techniques are increasingly being adopted in diagnostic medical imaging. However, the limited availability of high-quality, large-scale medical datasets presents a significant challenge, often necessitating the use of transfer learning approaches. This study investigates self-supervised learning methods for pre-training capsule networks in polyp diagnostics for colon cancer. We used the PICCOLO dataset, comprising 3,433 samples, which exemplifies typical challenges in medical datasets: small size, class imbalance, and distribution shifts between data splits. Capsule networks offer inherent interpretability due to their architecture and inter-layer information routing mechanism. However, their limited native implementation in mainstream deep learning frameworks and the lack of pre-trained versions pose a significant challenge. This is particularly true if aiming to train them on small medical datasets, where leveraging pre-trained weights as initial parameters would be beneficial. We explored two auxiliary self-supervised learning tasks, colourisation and contrastive learning, for capsule network pre-training. We compared self-supervised pre-trained models against alternative initialisation strategies. Our findings suggest that contrastive learning and in-painting techniques are suitable auxiliary tasks for self-supervised learning in the medical domain. These techniques helped guide the model to capture important visual features that are beneficial for the downstream task of polyp classification, increasing its accuracy by 5.26% compared to other weight initialisation methods.

Deep learning methods have demonstrated strong performance in objection tasks; however, their ability to learn domain-specific applications with limited training data remains a significant challenge. Transfer learning techniques address this issue by leveraging knowledge from pre-training on related datasets, enabling faster and more efficient learning for new tasks. Finding the right dataset for pre-training can play a critical role in determining the success of transfer learning and overall model performance. In this paper, we investigate the impact of pre-training a YOLOv8n model on seven distinct datasets, evaluating their effectiveness when transferred to the task of polyp detection. We compare whether large, general-purpose datasets with diverse objects outperform niche datasets with characteristics similar to polyps. In addition, we assess the influence of the size of the dataset on the efficacy of transfer learning. Experiments on the polyp datasets show that models pre-trained on relevant datasets consistently outperform those trained from scratch, highlighting the benefit of pre-training on datasets with shared domain-specific features.