arXiv subjects

Jennifer Alvén

Publications and source records attributed to Jennifer Alvén.

9 recordsLinked to original sources

arXiv2026

What Matters is the Prompt: Prompt Sensitivity and Prompt Generation in Foundation Models for Lung Nodule Segmentation

Lung nodule segmentation in computed tomography is essential for extracting clinically relevant information for lung cancer assessment and treatment planning. Foundation models have shown notable segmentation capabilities, but state-of-the-art approaches often depend on input prompts, such as points or boxes, making their performance sensitive to prompt quality and placement. Understanding the limitations and constraints of prompt-based foundation models is therefore essential for designing reliable medical image segmentation solutions. In this work, we investigate how prompt quality affects foundation models performance for lung nodule segmentation. We further propose a synthetic prompt-generation model to test if the dependence on manually provided prompts can be mitigated by generating synthetic prompts that can also improve segmentation performance. Perturbation experiments show that bounding box prompts generally outperform point prompts, while latest specialized medical imaging models achieve better performance than general purpose ones. The proposed approach obtains a Dice coefficient of 0.85, suggesting that synthetic prompt generation as a promising strategy for lung nodule segmentation with foundation models.

eess.IV↗

arXiv2026

CT-CLIP Representations for Multimodal Lung Cancer Survival Prediction

Accurate prognosis prediction is important for treatment planning in lung cancer, but deep learning-driven survival modelling is often limited by the scarcity of curated imaging cohorts with reliable outcome data. This study evaluates whether representations from a domain-specific foundation model can be used for multimodal survival prediction in data-constrained clinical settings. We assess the foundation model CT-CLIP as a feature extractor for pretreatment computed tomography images and clinical variables from 242 diagnosed lung cancer patients. The evaluation includes adaptation strategies based on frozen encoders, full fine-tuning, and low-rank adaptation, together with modality ablations and comparisons with clinical and multimodal baselines. The results show that a frozen CT-CLIP model combined with a trainable lightweight survival head outperforms the clinical baseline and achieves comparable or improved performance relative to other multimodal approaches, and separates patients into clinically meaningful high- and low-risk groups.

cs.CV↗

arXiv2026

Trexplorer Super: Topologically Correct Centerline Tree Tracking of Tubular Objects in CT Volumes

Tubular tree structures, such as blood vessels and airways, are essential in human anatomy and accurately tracking them while preserving their topology is crucial for various downstream tasks. Trexplorer is a recurrent model designed for centerline tracking in 3D medical images but it struggles with predicting duplicate branches and terminating tracking prematurely. To address these issues, we present Trexplorer Super, an enhanced version that notably improves performance through novel advancements. However, evaluating centerline tracking models is challenging due to the lack of public datasets. To enable thorough evaluation, we develop three centerline datasets, one synthetic and two real, each with increasing difficulty. Using these datasets, we conduct a comprehensive evaluation of existing state-of-the-art (SOTA) models and compare them with our approach. Trexplorer Super outperforms previous SOTA models on every dataset. Our results also highlight that strong performance on synthetic data does not necessarily translate to real datasets. The code and datasets are available at https://github.com/RomStriker/Trexplorer-Super.

cs.CV↗

arXiv2026

CEVAR: Centerline Embedding Extraction for Endovascular Aneurysm Repair

Long-term mortality rates after endovascular aneurysm repair (EVAR) remain elevated due to post-EVAR rupture caused by loss of seal in stent graft sealing zones. Structured CT review using centerline measurements improves detection, but current workflows require manual centerline editing and expert operators. We propose a transformer framework for automated, protocol-driven sealing zone assessment that combines 3D centerline tracking with embedding-based geometric prediction. Two state-of-the-art image-to-graph models are evaluated for aorto-iliac centerline extraction from follow-up CT and for measurement of stent position, vessel diameters, and seal lengths according to EVAR4C protocol. Across the full test set and a challenging no-contrast subset, the proposed fully automatic method outperforms the commercial semi-automatic workflow.

cs.CV↗

arXiv2026

Weakly-Supervised Lung Nodule Segmentation via Training-Free Guidance of 3D Rectified Flow

Dense annotations, such as segmentation masks, are expensive and time-consuming to obtain, especially for 3D medical images where expert voxel-wise labeling is required. Weakly supervised approaches aim to address this limitation, but often rely on attribution-based methods that struggle to accurately capture small structures such as lung nodules. In this paper, we propose a weakly-supervised segmentation method for lung nodules by combining pretrained state-of-the-art rectified flow and predictor models in a plug-and-play manner. Our approach uses training-free guidance of a 3D rectified flow model, requiring only fine-tuning of the predictor using image-level labels and no retraining of the generative model. The proposed method produces improved-quality segmentations for two separate predictors, consistently detecting lung nodules of varying size and shapes. Experiments on LUNA16 demonstrate improvements over baseline methods, highlighting the potential of generative foundation models as tools for weakly supervised 3D medical image segmentation.

cs.CV↗

arXiv2026

Medical Image Understanding Improves Survival Prediction via Visual Instruction Tuning

Accurate prognostication and risk estimation are essential for guiding clinical decision-making and optimizing patient management. While radiologist-assessed features from CT scans provide valuable indicators of disease severity and outcomes, interpreting such images requires expert knowledge, and translating rich visual information into textual summaries inevitably leads to information loss. In this work, we propose a vision-language framework for 3D CT image understanding that leverages large-scale open-sourced CT images paired with radiology reports through visual instruction tuning. This pre-training enables the model to learn clinically meaningful visual-textual representations, which can then be adapted to downstream survival prediction tasks. By incorporating a survival prediction head on top of the pre-trained model, our approach improves survival prediction from CT images and clinical data while generating clinically meaningful language responses to predefined questions. Experimental results demonstrate that our method outperforms baseline methods in survival prediction, particularly, when clinical data alone is less predictive. The code will be released upon acceptance.

cs.CV↗

arXiv2026

Exemplar Diffusion: Improving Medical Object Detection with Opportunistic Labels

We present a framework to take advantage of existing labels at inference, called \textit{exemplars}, in order to improve the performance of object detection in medical images. The method, \textit{exemplar diffusion}, leverages existing diffusion methods for object detection to enable a training-free approach to adding information of known bounding boxes at test time. We demonstrate that for medical image datasets with clear spatial structure, the method yields an across-the-board increase in average precision and recall, and a robustness to exemplar quality, enabling non-expert annotation. Moreover, we demonstrate how our method may also be used to quantify predictive uncertainty in diffusion detection methods. Source code and data splits openly available online: https://github.com/waahlstrand/ExemplarDiffusion

cs.CV↗

arXiv2026

RefTr: Recurrent Refinement of Confluent Trajectories for 3D Vascular Tree Centerlines

Tubular tree structures such as blood vessels and lung airways are central to many clinical tasks, including diagnosis, treatment planning, and surgical navigation. Accurate centerline extraction with correct topology is essential, as missing small branches can lead to incomplete assessments or overlooked abnormalities. We propose RefTr, a 3D image-to-graph framework that generates vascular centerlines via recurrent refinement of confluent trajectories. RefTr adopts a Transformer-based Producer-Refiner architecture in which the Producer predicts candidate trajectories and a shared Refiner iteratively refines them toward the target branches. The confluent trajectory representation enables whole-branch refinement while explicitly enforcing valid topology. This recurrent scheme improves precision and reduces decoder parameters by 2.4x compared to the state-of-the-art. We further introduce an efficient non-maximum suppression algorithm for spatial tree graphs to merge duplicate branches and extend evaluation metrics to be radius-aware for robust comparison. Experiments on multiple public datasets demonstrate stronger overall performance, faster inference, and substantially fewer parameters, highlighting the effectiveness of RefTr for 3D vascular tree analysis.

cs.CV↗

arXiv2024

Explainable vertebral fracture analysis with uncertainty estimation using differentiable rule-based classification

We present a novel method for explainable vertebral fracture assessment (XVFA) in low-dose radiographs using deep neural networks, incorporating vertebra detection and keypoint localization with uncertainty estimates. We incorporate Genant's semi-quantitative criteria as a differentiable rule-based means of classifying both vertebra fracture grade and morphology. Unlike previous work, XVFA provides explainable classifications relatable to current clinical methodology, as well as uncertainty estimations, while at the same time surpassing state-of-the art methods with a vertebra-level sensitivity of 93% and end-to-end AUC of 97% in a challenging setting. Moreover, we compare intra-reader agreement with model uncertainty estimates, with model reliability on par with human annotators.

eess.IV↗