Searcharxiv⌕ Search

arXiv subjects

Jonas Teuwen

Publications and source records attributed to Jonas Teuwen.

At least 19 recordsLinked to original sources
arXiv2026

MIRAGE: Multi-scale Lesion-Informed Representation with Auxiliary Guidance for MRI Contrast Enhancement

Inferring contrast enhancement from one pre-contrast breast MRI slice is underdetermined: post-contrast appearance contains physiological information that is not uniquely encoded in baseline anatomy. Optimizing only paired pixel fidelity can suppress uncertain lesion enhancement, whereas adversarial or stochastic generative objectives can favor realistic post-contrast appearance without guaranteeing patient-specific lesion fidelity. We introduce MIRAGE, a residual 2D U-Net that combines global reconstruction and perceptual losses with three forms of lesion-aware supervision available only during training: an asymmetric penalty for missed tumor enhancement, multi-scale auxiliary tumor segmentation, and guidance through a frozen post-contrast tumor segmentation nnU-Net. We evaluate the method on 301 cases from the multi-centre MAMA-SYNTH data using eight complementary image-, region-, radiomics-, and segmentation-based metrics. MIRAGE ranks first on six metrics and markedly improves downstream lesion localization over tuned pix2pix, conditional diffusion, and latent bridge-matching baselines. The generative alternatives retain advantages in LPIPS or contrast classification, revealing a clear fidelity-utility trade-off. Leave-one-in and leave-one-out ablations show that the losses are partly redundant for lesion localization but exert distinct effects on appearance, radiomics, and boundary accuracy. These results support task-aware synthesis while also showing that its apparent optimality is conditional on the downstream models and metrics used to define utility.

eess.IV↗
arXiv2026

LoGo-MR: Screening Breast MRI for Cancer Risk Prediction by Efficient Omni-Slice Modeling

Efficient and explainable breast cancer (BC) risk prediction is critical for large-scale population-based screening. Breast MRI provides functional information for personalized risk assessment. Yet effective modeling remains challenging as fully 3D CNNs capture volumetric context at high computational cost, whereas lightweight 2D CNNs fail to model inter-slice continuity. Importantly, breast MRI modeling for shor- and long-term BC risk stratification remains underexplored. In this study, we propose LoGo-MR, a 2.5D local-global structural modeling framework for five-year BC risk prediction. Aligned with clinical interpretation, our framework first employs neighbor-slice encoding to capture subtle local cues linked to short-term risk. It then integrates transformer-enhanced multiple-instance learning (MIL) to model distributed global patterns related to long-term risk and provide interpretable slice importance. We further apply this framework across axial, sagittal, and coronal planes as LoGo3-MR to capture complementary volumetric information. This multi-plane formulation enables voxel-level risk saliency mapping, which may assist radiologists in localizing risk-relevant regions during breast MRI interpretation. Evaluated on a large breast MRI screening cohort (~7.5K), our method outperforms 2D/3D baselines and existing SOTA MIL methods, achieving AUCs of 0.77-0.69 for 1- to 5-year prediction and improving C-index by ~6% over 3D CNNs. LoGo3-MR further improves overall performance with interpretable localization across three planes, and validation across seven backbones shows consistent gains. These results highlight the clinical potential of efficient MRI-based BC risk stratification for large-scale screening. Code will be released publicly.

cs.CV↗
arXiv2025

Equivariant Multiscale Learned Invertible Reconstruction for Cone Beam CT: From Simulated to Real Data

Cone Beam CT (CBCT) is an important imaging modality nowadays, however lower image quality of CBCT compared to more conventional Computed Tomography (CT) remains a limiting factor in CBCT applications. Deep learning reconstruction methods are a promising alternative to classical analytical and iterative reconstruction methods, but applying such methods to CBCT is often difficult due to the lack of ground truth data, memory limitations and the need for fast inference at clinically-relevant resolutions. In this work we propose LIRE++, an end-to-end rotationally-equivariant multiscale learned invertible primal-dual scheme for fast and memory-efficient CBCT reconstruction. Memory optimizations and multiscale reconstruction allow for fast training and inference, while rotational equivariance improves parameter efficiency. LIRE++ was trained on simulated projection data from a fast quasi-Monte Carlo CBCT projection simulator that we developed as well. Evaluated on synthetic data, LIRE++ gave an average improvement of 1 dB in Peak Signal-to-Noise Ratio over alternative deep learning baselines. On real clinical data, LIRE++ improved the average Mean Absolute Error between the reconstruction and the corresponding planning CT by 10 Hounsfield Units with respect to current proprietary state-of-the-art hybrid deep-learning/iterative method.

physics.med-ph↗
arXiv2025

Towards Modality- and Sampling-Universal Learning Strategies for Accelerating Cardiovascular Imaging: Summary of the CMRxRecon2024 Challenge

Cardiovascular health is vital to human well-being, and cardiac magnetic resonance (CMR) imaging is considered the {clinical reference standard} for diagnosing cardiovascular disease. However, its adoption is hindered by long scan times, complex contrasts, and inconsistent quality. While deep learning methods perform well on specific CMR imaging {sequences}, they often fail to generalize across modalities and sampling schemes. The lack of benchmarks for high-quality, fast CMR image reconstruction further limits technology comparison and adoption. The CMRxRecon2024 challenge, attracting over 200 teams from 18 countries, addressed these issues with two tasks: generalization to unseen {modalities} and robustness to diverse undersampling patterns. We introduced the largest public multi-{modality} CMR raw dataset, an open benchmarking platform, and shared code. Analysis of the best-performing solutions revealed that prompt-based adaptation and enhanced physics-driven consistency enabled strong cross-scenario performance. These findings establish principles for generalizable reconstruction models and advance clinically translatable AI in cardiovascular imaging.

eess.IV↗
arXiv2025

TAP-CT: 3D Task-Agnostic Pretraining of Computed Tomography Foundation Models

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.

cs.CV↗
arXiv2025

Foundation Models in Medical Imaging: A Review and Outlook

Foundation models (FMs) are changing the way medical images are analyzed by learning from large collections of unlabeled data. Instead of relying on manually annotated examples, FMs are pre-trained to learn general-purpose visual features that can later be adapted to specific clinical tasks with little additional supervision. In this review, we examine how FMs are being developed and applied in pathology, radiology, and ophthalmology, drawing on evidence from over 150 studies. We explain the core components of FM pipelines, including model architectures, self-supervised learning methods, and strategies for downstream adaptation. We also review how FMs are being used in each imaging domain and compare design choices across applications. Finally, we discuss key challenges and open questions to guide future research.

eess.IV↗
arXiv2025

From Explainable to Explained AI: Ideas for Falsifying and Quantifying Explanations

Explaining deep learning models is essential for clinical integration of medical image analysis systems. A good explanation highlights if a model depends on spurious features that undermines generalization and harms a subset of patients or, conversely, may present novel biological insights. Although techniques like GradCAM can identify influential features, they are measurement tools that do not themselves form an explanation. We propose a human-machine-VLM interaction system tailored to explaining classifiers in computational pathology, including multi-instance learning for whole-slide images. Our proof of concept comprises (1) an AI-integrated slide viewer to run sliding-window experiments to test claims of an explanation, and (2) quantification of an explanation's predictiveness using general-purpose vision-language models. The results demonstrate that this allows us to qualitatively test claims of explanations and can quantifiably distinguish competing explanations. This offers a practical path from explainable AI to explained AI in digital pathology and beyond. Code and prompts are available at https://github.com/nki-ai/x2x.

eess.IV↗
arXiv2025

Towards Robust Foundation Models for Digital Pathology

Biomedical Foundation Models (FMs) are rapidly transforming AI-enabled healthcare research and entering clinical validation. However, their susceptibility to learning non-biological technical features -- including variations in surgical/endoscopic techniques, laboratory procedures, and scanner hardware -- poses risks for clinical deployment. We present the first systematic investigation of pathology FM robustness to non-biological features. Our work (i) introduces measures to quantify FM robustness, (ii) demonstrates the consequences of limited robustness, and (iii) proposes a framework for FM robustification to mitigate these issues. Specifically, we developed PathoROB, a robustness benchmark with three novel metrics, including the robustness index, and four datasets covering 28 biological classes from 34 medical centers. Our experiments reveal robustness deficits across all 20 evaluated FMs, and substantial robustness differences between them. We found that non-robust FM representations can cause major diagnostic downstream errors and clinical blunders that prevent safe clinical adoption. Using more robust FMs and post-hoc robustification considerably reduced (but did not yet eliminate) the risk of such errors. This work establishes that robustness evaluation is essential for validating pathology FMs before clinical adoption and demonstrates that future FM development must integrate robustness as a core design principle. PathoROB provides a blueprint for assessing robustness across biomedical domains, guiding FM improvement efforts towards more robust, representative, and clinically deployable AI systems that prioritize biological information over technical artifacts.

eess.IV↗
arXiv2025

End-to-end Adaptive Dynamic Subsampling and Reconstruction for Cardiac MRI

$\textbf{Background:}$ Accelerating dynamic MRI is vital for advancing clinical applications and improving patient comfort. Commonly, deep learning (DL) methods for accelerated dynamic MRI reconstruction typically rely on uniformly applying non-adaptive predetermined or random subsampling patterns across all temporal frames of the dynamic acquisition. This approach fails to exploit temporal correlations or optimize subsampling on a case-by-case basis. $\textbf{Purpose:}$ To develop an end-to-end approach for adaptive dynamic MRI subsampling and reconstruction, capable of generating customized sampling patterns maximizing at the same time reconstruction quality. $\textbf{Methods:}$ We introduce the End-to-end Adaptive Dynamic Sampling and Reconstruction (E2E-ADS-Recon) for MRI framework, which integrates an adaptive dynamic sampler (ADS) that adapts the acquisition trajectory to each case for a given acceleration factor with a state-of-the-art dynamic reconstruction network, vSHARP, for reconstructing the adaptively sampled data into a dynamic image. The ADS can produce either frame-specific patterns or unified patterns applied to all temporal frames. E2E-ADS-Recon is evaluated under both frame-specific and unified 1D or 2D sampling settings, using dynamic cine cardiac MRI data and compared with vSHARP models employing standard subsampling trajectories, as well as pipelines where ADS was replaced by parameterized samplers optimized for dataset-specific schemes. $\textbf{Results:}$ E2E-ADS-Recon exhibited superior reconstruction quality, especially at high accelerations, in terms of standard quantitative metrics (SSIM, pSNR, NMSE). $\textbf{Conclusion:}$ The proposed framework improves reconstruction quality, highlighting the importance of case-specific subsampling optimization in dynamic MRI applications.

eess.IV↗
arXiv2025

Deep End-to-end Adaptive k-Space Sampling, Reconstruction, and Registration for Dynamic MRI

Dynamic MRI enables a range of clinical applications, including cardiac function assessment, organ motion tracking, and radiotherapy guidance. However, fully sampling the dynamic k-space data is often infeasible due to time constraints and physiological motion such as respiratory and cardiac motion. This necessitates undersampling, which degrades the quality of reconstructed images. Poor image quality not only hinders visualization but also impairs the estimation of deformation fields, crucial for registering dynamic (moving) images to a static reference image. This registration enables tasks such as motion correction, treatment planning, and quantitative analysis in applications like cardiac imaging and MR-guided radiotherapy. To overcome the challenges posed by undersampling and motion, we introduce an end-to-end deep learning (DL) framework that integrates adaptive dynamic k-space sampling, reconstruction, and registration. Our approach begins with a DL-based adaptive sampling strategy, optimizing dynamic k-space acquisition to capture the most relevant data for each specific case. This is followed by a DL-based reconstruction module that produces images optimized for accurate deformation field estimation from the undersampled moving data. Finally, a registration module estimates the deformation fields aligning the reconstructed dynamic images with a static reference. The proposed framework is independent of specific reconstruction and registration modules allowing for plug-and-play integration of these components. The entire framework is jointly trained using a combination of supervised and unsupervised loss functions, enabling end-to-end optimization for improved performance across all components. Through controlled experiments and ablation studies, we validate each component, demonstrating that each choice contributes to robust motion estimation from undersampled dynamic data.

eess.IV↗
arXiv2025

Current Pathology Foundation Models are unrobust to Medical Center Differences

Pathology Foundation Models (FMs) hold great promise for healthcare. Before they can be used in clinical practice, it is essential to ensure they are robust to variations between medical centers. We measure whether pathology FMs focus on biological features like tissue and cancer type, or on the well known confounding medical center signatures introduced by staining procedure and other differences. We introduce the Robustness Index. This novel robustness metric reflects to what degree biological features dominate confounding features. Ten current publicly available pathology FMs are evaluated. We find that all current pathology foundation models evaluated represent the medical center to a strong degree. Significant differences in the robustness index are observed. Only one model so far has a robustness index greater than one, meaning biological features dominate confounding features, but only slightly. A quantitative approach to measure the influence of medical center differences on FM-based prediction performance is described. We analyze the impact of unrobustness on classification performance of downstream models, and find that cancer-type classification errors are not random, but specifically attributable to same-center confounders: images of other classes from the same medical center. We visualize FM embedding spaces, and find these are more strongly organized by medical centers than by biological factors. As a consequence, the medical center of origin is predicted more accurately than the tissue source and cancer type. The robustness index introduced here is provided with the aim of advancing progress towards clinical adoption of robust and reliable pathology FMs.

cs.LG↗
arXiv2025

ECTIL: Label-efficient Computational Tumour Infiltrating Lymphocyte (TIL) assessment in breast cancer: Multicentre validation in 2,340 patients with breast cancer

The level of tumour-infiltrating lymphocytes (TILs) is a prognostic factor for patients with (triple-negative) breast cancer (BC). Computational TIL assessment (CTA) has the potential to assist pathologists in this labour-intensive task, but current CTA models rely heavily on many detailed annotations. We propose and validate a fundamentally simpler deep learning based CTA that can be trained in only ten minutes on hundredfold fewer pathologist annotations. We collected whole slide images (WSIs) with TILs scores and clinical data of 2,340 patients with BC from six cohorts including three randomised clinical trials. Morphological features were extracted from whole slide images (WSIs) using a pathology foundation model. Our label-efficient Computational stromal TIL assessment model (ECTIL) directly regresses the TILs score from these features. ECTIL trained on only a few hundred samples (ECTIL-TCGA) showed concordance with the pathologist over five heterogeneous external cohorts (r=0.54-0.74, AUROC=0.80-0.94). Training on all slides of five cohorts (ECTIL-combined) improved results on a held-out test set (r=0.69, AUROC=0.85). Multivariable Cox regression analyses indicated that every 10% increase of ECTIL scores was associated with improved overall survival independent of clinicopathological variables (HR 0.86, p<0.01), similar to the pathologist score (HR 0.87, p<0.001). We demonstrate that ECTIL is highly concordant with an expert pathologist and obtains a similar hazard ratio. ECTIL has a fundamentally simpler design than existing methods and can be trained on orders of magnitude fewer annotations. Such a CTA may be used to pre-screen patients for, e.g., immunotherapy clinical trial inclusion, or as a tool to assist clinicians in the diagnostic work-up of patients with BC. Our model is available under an open source licence (https://github.com/nki-ai/ectil).

eess.IV↗
arXiv2024

Joint Supervised and Self-supervised Learning for MRI Reconstruction

Magnetic Resonance Imaging (MRI) represents an important diagnostic modality; however, its inherently slow acquisition process poses challenges in obtaining fully-sampled $k$-space data under motion. In the absence of fully-sampled acquisitions, serving as ground truths, training deep learning algorithms in a supervised manner to predict the underlying ground truth image becomes challenging. To address this limitation, self-supervised methods have emerged as a viable alternative, leveraging available subsampled $k$-space data to train deep neural networks for MRI reconstruction. Nevertheless, these approaches often fall short when compared to supervised methods. We propose Joint Supervised and Self-supervised Learning (JSSL), a novel training approach for deep learning-based MRI reconstruction algorithms aimed at enhancing reconstruction quality in cases where target datasets containing fully-sampled $k$-space measurements are unavailable. JSSL operates by simultaneously training a model in a self-supervised learning setting, using subsampled data from the target dataset(s), and in a supervised learning manner, utilizing datasets with fully-sampled $k$-space data, referred to as proxy datasets. We demonstrate JSSL's efficacy using subsampled prostate or cardiac MRI data as the target datasets, with fully-sampled brain and knee, or brain, knee and prostate $k$-space acquisitions, respectively, as proxy datasets. Our results showcase substantial improvements over conventional self-supervised methods, validated using common image quality metrics. Furthermore, we provide theoretical motivations for JSSL and establish "rule-of-thumb" guidelines for training MRI reconstruction models. JSSL effectively enhances MRI reconstruction quality in scenarios where fully-sampled $k$-space data is not available, leveraging the strengths of supervised learning by incorporating proxy datasets.

eess.IV↗
arXiv2024

Deep Multi-contrast Cardiac MRI Reconstruction via vSHARP with Auxiliary Refinement Network

Cardiac MRI (CMRI) is a cornerstone imaging modality that provides in-depth insights into cardiac structure and function. Multi-contrast CMRI (MCCMRI), which acquires sequences with varying contrast weightings, significantly enhances diagnostic capabilities by capturing a wide range of cardiac tissue characteristics. However, MCCMRI is often constrained by lengthy acquisition times and susceptibility to motion artifacts. To mitigate these challenges, accelerated imaging techniques that use k-space undersampling via different sampling schemes at acceleration factors have been developed to shorten scan durations. In this context, we propose a deep learning-based reconstruction method for 2D dynamic multi-contrast, multi-scheme, and multi-acceleration MRI. Our approach integrates the state-of-the-art vSHARP model, which utilizes half-quadratic variable splitting and ADMM optimization, with a Variational Network serving as an Auxiliary Refinement Network (ARN) to better adapt to the diverse nature of MCCMRI data. Specifically, the subsampled k-space data is fed into the ARN, which produces an initial prediction for the denoising step used by vSHARP. This, along with the subsampled k-space, is then used by vSHARP to generate high-quality 2D sequence predictions. Our method outperforms traditional reconstruction techniques and other vSHARP-based models.

eess.IV↗
arXiv2024

Ordinal Learning: Longitudinal Attention Alignment Model for Predicting Time to Future Breast Cancer Events from Mammograms

Precision breast cancer (BC) risk assessment is crucial for developing individualized screening and prevention. Despite the promising potential of recent mammogram (MG) based deep learning models in predicting BC risk, they mostly overlook the 'time-to-future-event' ordering among patients and exhibit limited explorations into how they track history changes in breast tissue, thereby limiting their clinical application. In this work, we propose a novel method, named OA-BreaCR, to precisely model the ordinal relationship of the time to and between BC events while incorporating longitudinal breast tissue changes in a more explainable manner. We validate our method on public EMBED and inhouse datasets, comparing with existing BC risk prediction and time prediction methods. Our ordinal learning method OA-BreaCR outperforms existing methods in both BC risk and time-to-future-event prediction tasks. Additionally, ordinal heatmap visualizations show the model's attention over time. Our findings underscore the importance of interpretable and precise risk assessment for enhancing BC screening and prevention efforts. The code will be accessible to the public.

eess.IV↗
arXiv2024

vSHARP: variable Splitting Half-quadratic Admm algorithm for Reconstruction of inverse-Problems

Medical Imaging (MI) tasks, such as accelerated parallel Magnetic Resonance Imaging (MRI), often involve reconstructing an image from noisy or incomplete measurements. This amounts to solving ill-posed inverse problems, where a satisfactory closed-form analytical solution is not available. Traditional methods such as Compressed Sensing (CS) in MRI reconstruction can be time-consuming or prone to obtaining low-fidelity images. Recently, a plethora of Deep Learning (DL) approaches have demonstrated superior performance in inverse-problem solving, surpassing conventional methods. In this study, we propose vSHARP (variable Splitting Half-quadratic ADMM algorithm for Reconstruction of inverse Problems), a novel DL-based method for solving ill-posed inverse problems arising in MI. vSHARP utilizes the Half-Quadratic Variable Splitting method and employs the Alternating Direction Method of Multipliers (ADMM) to unroll the optimization process. For data consistency, vSHARP unrolls a differentiable gradient descent process in the image domain, while a DL-based denoiser, such as a U-Net architecture, is applied to enhance image quality. vSHARP also employs a dilated-convolution DL-based model to predict the Lagrange multipliers for the ADMM initialization. We evaluate vSHARP on tasks of accelerated parallel MRI Reconstruction using two distinct datasets and on accelerated parallel dynamic MRI Reconstruction using another dataset. Our comparative analysis with state-of-the-art methods demonstrates the superior performance of vSHARP in these applications.

eess.IV↗
arXiv2024

The state-of-the-art in Cardiac MRI Reconstruction: Results of the CMRxRecon Challenge in MICCAI 2023

Cardiac MRI, crucial for evaluating heart structure and function, faces limitations like slow imaging and motion artifacts. Undersampling reconstruction, especially data-driven algorithms, has emerged as a promising solution to accelerate scans and enhance imaging performance using highly under-sampled data. Nevertheless, the scarcity of publicly available cardiac k-space datasets and evaluation platform hinder the development of data-driven reconstruction algorithms. To address this issue, we organized the Cardiac MRI Reconstruction Challenge (CMRxRecon) in 2023, in collaboration with the 26th International Conference on MICCAI. CMRxRecon presented an extensive k-space dataset comprising cine and mapping raw data, accompanied by detailed annotations of cardiac anatomical structures. With overwhelming participation, the challenge attracted more than 285 teams and over 600 participants. Among them, 22 teams successfully submitted Docker containers for the testing phase, with 7 teams submitted for both cine and mapping tasks. All teams use deep learning based approaches, indicating that deep learning has predominately become a promising solution for the problem. The first-place winner of both tasks utilizes the E2E-VarNet architecture as backbones. In contrast, U-Net is still the most popular backbone for both multi-coil and single-coil reconstructions. This paper provides a comprehensive overview of the challenge design, presents a summary of the submitted results, reviews the employed methods, and offers an in-depth discussion that aims to inspire future advancements in cardiac MRI reconstruction models. The summary emphasizes the effective strategies observed in Cardiac MRI reconstruction, including backbone architecture, loss function, pre-processing techniques, physical modeling, and model complexity, thereby providing valuable insights for further developments in this field.

eess.IV↗