arXiv subjects

Maria Vakalopoulou

Publications and source records attributed to Maria Vakalopoulou.

At least 19 recordsLinked to original sources

arXiv2026

CAR-MIL: Counterfactual Attention Regularization for Multiple Instance Learning

Multiple Instance Learning (MIL) is widely used for weakly supervised learning, particularly in digital pathology, where fine-grained annotations are costly. Most MIL methods aggregate instance features via attention mechanisms. However, attention weights do not always faithfully reflect instance importance and may focus on spuriously correlated regions. In this work, we propose CAR-MIL, a framework that explicitly guides attention learning through a counterfactual attention regularization objective inspired by counterfactual explanations. Built on a standard attention-based MIL architecture, our approach introduces a lightweight counterfactual attention branch trained to produce an alternative prediction while remaining close to the factual attention distribution. This encourages prediction changes to arise from minimal, structured redistributions of attention, leading to more informative evidence allocation. The resulting factual and counterfactual attention maps capture complementary evidence: the former highlights regions supporting the prediction, while the latter reveals regions whose reweighting would challenge it. We evaluate our method on synthetic MIL benchmarks with instance-level ground truth enabling controlled analysis of attention behavior and on five digital pathology datasets across four tasks. CAR-MIL maintains competitive classification performance, with the largest gains observed on more challenging tasks, while improving attention reliability, demonstrating the benefits of integrating counterfactual explainability reasoning into attention learning. Code is available at: https://github.com/ImaneCR/CAR-MIL/.

cs.CV↗

arXiv2026

Beyond the Hard Budget: Sparsity Regularizers for More Interpretable Top-k Sparse Autoencoders

Sparse autoencoders (SAEs) have become a leading tool for interpreting the representations of vision foundation models, decomposing their polysemantic activations into a larger set of sparse, more monosemantic features. The Top-$k$ SAE, a now-standard variant, enforces sparsity architecturally through its activation function, retaining only the $k$ most active latents per input. Because it was designed precisely to avoid the $\ell_1$ penalty used by earlier SAEs and its known drawbacks, it has not been combined with an explicit sparsity regularizer. Yet the Top-$k$ SAE retains limitations of its own, and we hypothesize that a sparsity penalty acting before the selection could sharpen each latent's selectivity and make the code more interpretable, without reintroducing the drawbacks of the $\ell_1$ penalty. We introduce two sparsity regularizers compatible with the Top-$k$ architecture, both acting on the activations before the Top-$k$ selection: an $\ell_1$ penalty on the unselected (off-support) units, and a scale-invariant $\ell_1/\ell_2$-ratio penalty that concentrates the code onto fewer effective units. Both penalties are applied only to the batch-active units, those selected by the Top-$k$ operator at least once within the batch. Across two datasets, three vision foundation models, and a range of $k$, both regularizers consistently improve monosemanticity at no cost to reconstruction quality. The $\ell_1/\ell_2$ penalty further concentrates information into fewer latents, making reconstruction more robust to the inference-time choice of $k$ and improving small-budget linear probing. Our central finding is that hard architectural sparsity and soft sparsity regularization are complementary rather than mutually exclusive.

cs.LG↗

arXiv2026

From Patches to Patients: A study of the tile-to-slide performance transferability in Digital Pathology

Foundation Models (FMs) have recently redefined the state-of-the-art in histopathology by providing robust representations for whole-slide image (WSI) analysis. However, selecting the optimal foundation model (FM) for a specific clinical cohort currently requires multiple preprocessing steps, followed by computationally expensive feature extraction and the training of a Multiple Instance Learning (MIL) aggregator for every model. In this work, we investigate whether efficient tile-level linear probing can serve as a reliable proxy for slide-level performance, reducing the need to run full slide-level pipelines for every candidate encoder. We benchmark 19 state-of-the-art FMs on 42 slide-level and 16 tile-level tasks, comparing tile probing metrics against slide-level outcomes using ABMIL and Mean Pooling aggregations. We observe a high correlation between tile and slide performance across varying task difficulties, indicating that encoder representation quality is the primary determinant of WSI success. Sensitivity analyses show that transferability is stable across models and is more influenced by cohort sizes and numbers of tiles per slide than by average task difficulty. We also measure the agreement in best performing models between tile and slide-level tasks, showing tile benchmarks reliably shortlist strong candidates. Overall, our study indicates that tile-level benchmarking provides an efficient and practical first step for narrowing down candidate models, while slide-level evaluation remains essential for final validation on clinical tasks.

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arXiv2026

Medical Context Distorts Decisions in Clinical Vision Language Models

Vision-language models (VLMs) are increasingly proposed for clinical decision support, yet their reliability in real-world scenarios that require integrating both visual and textual context from medical records remains poorly characterized. This paper identifies three failure modes: (1) modality over-reliance on text over images, (2) spurious reliance on irrelevant clinical history, and (3) prompt sensitivity across semantically equivalent inputs. We evaluate a diverse set of general-domain and medically-tuned open and closed VLMs on chest x-ray tasks using MIMIC-CXR. By systematically manipulating image-text alignment, clinical history, and prompt formulations, we found that VLM decisions are dominated by the text modality, even when visual evidence is available. Moreover, we observed that VLMs are heavily influenced by irrelevant reports, while minor prompt changes can reverse correct image-based predictions. Our findings underscore the need for explicit safeguards and stress-testing before considering the use of these models in clinical practice.

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arXiv2026

Mamba-driven MRI-to-CT Synthesis for MRI-only Radiotherapy Planning

Radiotherapy workflows for oncological patients increasingly rely on multi-modal medical imaging, commonly involving both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). MRI-only treatment planning has emerged as an attractive alternative, as it reduces patient exposure to ionizing radiation and avoids errors introduced by inter-modality registration. While nnU-Net-based frameworks are predominantly used for MRI-to-CT synthesis, we explore Mamba-based architectures for this task to investigate the applicability of state-space modeling for cross-modality medical image translation and assess its performance relative to established convolutional architectures. Specifically, we adapt the SegMamba architecture, originally proposed for segmentation, to perform image-to-image generation. Our 3D Mamba architecture effectively captures complex volumetric features and long-range dependencies, thus allowing accurate CT synthesis while maintaining a relatively low parameter count. Experiments were conducted on a subset of SynthRAD2025 dataset, comprising registered single-channel MRI-CT volume pairs across three anatomical regions. Quantitative evaluation is performed via a combination of image similarity metrics computed in Hounsfield Units (HU) and segmentation-based metrics obtained from TotalSegmentator to ensure geometric consistency is preserved. The findings pave the way for the integration of state-space models into radiotherapy workflows.

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arXiv2026

On the Cone Effect and Modality Gap in Medical Vision-Language Embeddings

Vision-Language Models (VLMs) exhibit a characteristic "cone effect" in which nonlinear encoders map embeddings into highly concentrated regions of the representation space, contributing to cross-modal separation known as the modality gap. While this phenomenon has been widely observed, its practical impact on supervised multimodal learning -- particularly in medical domains -- remains unclear. In this work, we introduce a lightweight post-hoc mechanism that keeps pretrained VLM encoders frozen while continuously controlling cross-modal separation through a single hyperparameter {{\lambda}}. This enables systematic analysis of how the modality gap affects downstream multimodal performance without expensive retraining. We evaluate generalist (CLIP, SigLIP) and medically specialized (BioMedCLIP, MedSigLIP) models across diverse medical and natural datasets in a supervised multimodal settings. Results consistently show that reducing excessive modality gap improves downstream performance, with medical datasets exhibiting stronger sensitivity to gap modulation; however, fully collapsing the gap is not always optimal, and intermediate, task-dependent separation yields the best results. These findings position the modality gap as a tunable property of multimodal representations rather than a quantity that should be universally minimized.

cs.LG↗

arXiv2026

GATE-AD: Graph Attention Network Encoding For Few-Shot Industrial Visual Anomaly Detection

Few-Shot Industrial Visual Anomaly Detection (FS-IVAD) comprises a critical task in modern manufacturing settings, where automated product inspection systems need to identify rare defects using only a handful of normal/defect-free training samples. In this context, the current study introduces a novel reconstruction-based approach termed GATE-AD. In particular, the proposed framework relies on the employment of a masked, representation-aligned Graph Attention Network (GAT) encoding scheme to learn robust appearance patterns of normal samples. By leveraging dense, patch-level, visual feature tokens as graph nodes, the model employs stacked self-attentional layers to adaptively encode complex, irregular, non-Euclidean, local relations. The graph is enhanced with a representation alignment component grounded on a learnable, latent space, where high reconstruction residual areas (i.e., defects) are assessed using a Scaled Cosine Error (SCE) objective function. Extensive comparative evaluation on the MVTec AD, VisA, and MPDD industrial defect detection benchmarks demonstrates that GATE-AD achieves state-of-the-art performance across the $1$- to $8$-shot settings, combining the highest detection accuracy (increase up to $1.8\%$ in image AUROC in the 8-shot case in MPDD) with the lowest per-image inference latency (at least $25.05\%$ faster), compared to the best-performing literature methods. In order to facilitate reproducibility and further research, the source code of GATE-AD is available at https://github.com/gthpapadopoulos/GATE-AD.

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arXiv2026

Information Maximization for Long-Tailed Semi-Supervised Domain Generalization

Semi-supervised domain generalization (SSDG) has recently emerged as an appealing alternative to tackle domain generalization when labeled data is scarce but unlabeled samples across domains are abundant. In this work, we identify an important limitation that hampers the deployment of state-of-the-art methods on more challenging but practical scenarios. In particular, state-of-the-art SSDG severely suffers in the presence of long-tailed class distributions, an arguably common situation in real-world settings. To alleviate this limitation, we propose IMaX, a simple yet effective objective based on the well-known InfoMax principle adapted to the SSDG scenario, where the Mutual Information (MI) between the learned features and latent labels is maximized, constrained by the supervision from the labeled samples. Our formulation integrates an {\alpha}-entropic objective, which mitigates the class-balance bias encoded in the standard marginal entropy term of the MI, thereby better handling arbitrary class distributions. IMaX can be seamlessly plugged into recent state-of-the-art SSDG, consistently enhancing their performance, as demonstrated empirically across two different image modalities.

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arXiv2026

Mask-HybridGNet: Graph-based segmentation with emergent anatomical correspondence from pixel-level supervision

Graph-based medical image segmentation represents anatomical structures using boundary graphs, providing fixed-topology landmarks and inherent population-level correspondences. However, their clinical adoption has been hindered by a major requirement: training datasets with manually annotated landmarks that maintain point-to-point correspondences across patients rarely exist in practice. We introduce Mask-HybridGNet, a framework that trains graph-based models directly using standard pixel-wise masks, eliminating the need for manual landmark annotations. Our approach aligns variable-length ground truth boundaries with fixed-length landmark predictions by combining Chamfer distance supervision and edge-based regularization to ensure local smoothness and regular landmark distribution, further refined via differentiable rasterization. A significant emergent property of this framework is that predicted landmark positions become consistently associated with specific anatomical locations across patients without explicit correspondence supervision. This implicit atlas learning enables temporal tracking, cross-slice reconstruction, and morphological population analyses. Beyond direct segmentation, Mask-HybridGNet can extract correspondences from existing segmentation masks, allowing it to generate stable anatomical atlases from any high-quality pixel-based model. Experiments across chest radiography, cardiac ultrasound, cardiac MRI, and fetal imaging demonstrate that our model achieves competitive results against state-of-the-art pixel-based methods, while ensuring anatomical plausibility by enforcing boundary connectivity through a fixed graph adjacency matrix. This framework leverages the vast availability of standard segmentation masks to build structured models that maintain topological integrity and provide implicit correspondences.

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arXiv2026

A High-Level Survey of Optical Remote Sensing

In recent years, significant advances in computer vision have also propelled progress in remote sensing. Concurrently, the use of drones has expanded, with many organizations incorporating them into their operations. Most drones are equipped by default with RGB cameras, which are both robust and among the easiest sensors to use and interpret. The body of literature on optical remote sensing is vast, encompassing diverse tasks, capabilities, and methodologies. Each task or methodology could warrant a dedicated survey. This work provides a comprehensive overview of the capabilities of the field, while also presenting key information, such as datasets and insights. It aims to serve as a guide for researchers entering the field, offering high-level insights and helping them focus on areas most relevant to their interests. To the best of our knowledge, no existing survey addresses this holistic perspective.

cs.CV↗

arXiv2026

OCTOPUS: Enhancing the Spatial-Awareness of Vision SSMs with Multi-Dimensional Scans and Traversal Selection

State space models (SSMs) have recently emerged as an alternative to transformers due to their unique ability of modeling global relationships in text with linear complexity. However, their success in vision tasks has been limited due to their causal formulation, which is suitable for sequential text but detrimental in the spatial domain where causality breaks the inherent spatial relationships among pixels or patches. As a result, standard SSMs fail to capture local spatial coherence, often linking non-adjacent patches while ignoring neighboring ones that are visually correlated. To address these limitations, we introduce OCTOPUS , a novel architecture that preserves both global context and local spatial structure within images, while maintaining the linear complexity of SSMs. OCTOPUS performs discrete reoccurrence along eight principal orientations, going forward or backward in the horizontal, vertical, and diagonal directions, allowing effective information exchange across all spatially connected regions while maintaining independence among unrelated patches. This design enables multi-directional recurrence, capturing both global context and local spatial structure with SSM-level efficiency. In our classification and segmentation benchmarks, OCTOPUS demonstrates notable improvements in boundary preservation and region consistency, as evident from the segmentation results, while maintaining relatively better classification accuracy compared to existing V-SSM based models. These results suggest that OCTOPUS appears as a foundation method for multi-directional recurrence as a scalable and effective mechanism for building spatially aware and computationally efficient vision architectures.

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arXiv2026

Class Adaptive Conformal Training

Deep neural networks have achieved remarkable success across a variety of tasks, yet they often suffer from unreliable probability estimates. As a result, they can be overconfident in their predictions. Conformal Prediction (CP) offers a principled framework for uncertainty quantification, yielding prediction sets with rigorous coverage guarantees. Existing conformal training methods optimize for overall set size, but shaping the prediction sets in a class-conditional manner is not straightforward and typically requires prior knowledge of the data distribution. In this work, we introduce Class Adaptive Conformal Training (CaCT), which formulates conformal training as an augmented Lagrangian optimization problem that adaptively learns to shape prediction sets class-conditionally without making any distributional assumptions. Experiments on multiple benchmark datasets, including standard and long-tailed image recognition as well as text classification, demonstrate that CaCT consistently outperforms prior conformal training methods, producing significantly smaller and more informative prediction sets while maintaining the desired coverage guarantees.

cs.LG↗

arXiv2026

SoC: Semantic Orthogonal Calibration for Test-Time Prompt Tuning

With the increasing adoption of vision-language models (VLMs) in critical decision-making systems such as healthcare or autonomous driving, the calibration of their uncertainty estimates becomes paramount. Yet, this dimension has been largely underexplored in the VLM test-time prompt-tuning (TPT) literature, which has predominantly focused on improving their discriminative performance. Recent state-of-the-art advocates for enforcing full orthogonality over pairs of text prompt embeddings to enhance separability, and therefore calibration. Nevertheless, as we theoretically show in this work, the inherent gradients from fully orthogonal constraints will strongly push semantically related classes away, ultimately making the model overconfident. Based on our findings, we propose Semantic Orthogonal Calibration (SoC), a Huber-based regularizer that enforces smooth prototype separation while preserving semantic proximity, thereby improving calibration compared to prior orthogonality-based approaches. Across a comprehensive empirical validation, we demonstrate that SoC consistently improves calibration performance, while also maintaining competitive discriminative capabilities.

cs.CV↗

arXiv2025

TICON: A Slide-Level Tile Contextualizer for Histopathology Representation Learning

The interpretation of small tiles in large whole slide images (WSI) often needs a larger image context. We introduce TICON, a transformer-based tile representation contextualizer that produces rich, contextualized embeddings for ''any'' application in computational pathology. Standard tile encoder-based pipelines, which extract embeddings of tiles stripped from their context, fail to model the rich slide-level information essential for both local and global tasks. Furthermore, different tile-encoders excel at different downstream tasks. Therefore, a unified model is needed to contextualize embeddings derived from ''any'' tile-level foundation model. TICON addresses this need with a single, shared encoder, pretrained using a masked modeling objective to simultaneously unify and contextualize representations from diverse tile-level pathology foundation models. Our experiments demonstrate that TICON-contextualized embeddings significantly improve performance across many different tasks, establishing new state-of-the-art results on tile-level benchmarks (i.e., HEST-Bench, THUNDER, CATCH) and slide-level benchmarks (i.e., Patho-Bench). Finally, we pretrain an aggregator on TICON to form a slide-level foundation model, using only 11K WSIs, outperforming SoTA slide-level foundation models pretrained with up to 350K WSIs.

cs.CV↗

arXiv2025

CAPRMIL: Context-Aware Patch Representations for Multiple Instance Learning

In computational pathology, weak supervision has become the standard for deep learning due to the gigapixel scale of WSIs and the scarcity of pixel-level annotations, with Multiple Instance Learning (MIL) established as the principal framework for slide-level model training. In this paper, we introduce a novel setting for MIL methods, inspired by proceedings in Neural Partial Differential Equation (PDE) Solvers. Instead of relying on complex attention-based aggregation, we propose an efficient, aggregator-agnostic framework that removes the complexity of correlation learning from the MIL aggregator. CAPRMIL produces rich context-aware patch embeddings that promote effective correlation learning on downstream tasks. By projecting patch features -- extracted using a frozen patch encoder -- into a small set of global context/morphology-aware tokens and utilizing multi-head self-attention, CAPRMIL injects global context with linear computational complexity with respect to the bag size. Paired with a simple Mean MIL aggregator, CAPRMIL matches state-of-the-art slide-level performance across multiple public pathology benchmarks, while reducing the total number of trainable parameters by 48%-92.8% versus SOTA MILs, lowering FLOPs during inference by 52%-99%, and ranking among the best models on GPU memory efficiency and training time. Our results indicate that learning rich, context-aware instance representations before aggregation is an effective and scalable alternative to complex pooling for whole-slide analysis. Our code is available at https://github.com/mandlos/CAPRMIL

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arXiv2025

PVeRA: Probabilistic Vector-Based Random Matrix Adaptation

Large foundation models have emerged in the last years and are pushing performance boundaries for a variety of tasks. Training or even finetuning such models demands vast datasets and computational resources, which are often scarce and costly. Adaptation methods provide a computationally efficient solution to address these limitations by allowing such models to be finetuned on small amounts of data and computing power. This is achieved by appending new trainable modules to frozen backbones with only a fraction of the trainable parameters and fitting only these modules on novel tasks. Recently, the VeRA adapter was shown to excel in parameter-efficient adaptations by utilizing a pair of frozen random low-rank matrices shared across all layers. In this paper, we propose PVeRA, a probabilistic version of the VeRA adapter, which modifies the low-rank matrices of VeRA in a probabilistic manner. This modification naturally allows handling inherent ambiguities in the input and allows for different sampling configurations during training and testing. A comprehensive evaluation was performed on the VTAB-1k benchmark and seven adapters, with PVeRA outperforming VeRA and other adapters. Our code for training models with PVeRA and benchmarking all adapters is available https://github.com/leofillioux/pvera.

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arXiv2025

Multimodal Carotid Risk Stratification with Large Vision-Language Models: Benchmarking, Fine-Tuning, and Clinical Insights

Reliable risk assessment for carotid atheromatous disease remains a major clinical challenge, as it requires integrating diverse clinical and imaging information in a manner that is transparent and interpretable to clinicians. This study investigates the potential of state-of-the-art and recent large vision-language models (LVLMs) for multimodal carotid plaque assessment by integrating ultrasound imaging (USI) with structured clinical, demographic, laboratory, and protein biomarker data. A framework that simulates realistic diagnostic scenarios through interview-style question sequences is proposed, comparing a range of open-source LVLMs, including both general-purpose and medically tuned models. Zero-shot experiments reveal that even if they are very powerful, not all LVLMs can accurately identify imaging modality and anatomy, while all of them perform poorly in accurate risk classification. To address this limitation, LLaVa-NeXT-Vicuna is adapted to the ultrasound domain using low-rank adaptation (LoRA), resulting in substantial improvements in stroke risk stratification. The integration of multimodal tabular data in the form of text further enhances specificity and balanced accuracy, yielding competitive performance compared to prior convolutional neural network (CNN) baselines trained on the same dataset. Our findings highlight both the promise and limitations of LVLMs in ultrasound-based cardiovascular risk prediction, underscoring the importance of multimodal integration, model calibration, and domain adaptation for clinical translation.

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arXiv2025

Controllable Latent Space Augmentation for Digital Pathology

Whole slide image (WSI) analysis in digital pathology presents unique challenges due to the gigapixel resolution of WSIs and the scarcity of dense supervision signals. While Multiple Instance Learning (MIL) is a natural fit for slide-level tasks, training robust models requires large and diverse datasets. Even though image augmentation techniques could be utilized to increase data variability and reduce overfitting, implementing them effectively is not a trivial task. Traditional patch-level augmentation is prohibitively expensive due to the large number of patches extracted from each WSI, and existing feature-level augmentation methods lack control over transformation semantics. We introduce HistAug, a fast and efficient generative model for controllable augmentations in the latent space for digital pathology. By conditioning on explicit patch-level transformations (e.g., hue, erosion), HistAug generates realistic augmented embeddings while preserving initial semantic information. Our method allows the processing of a large number of patches in a single forward pass efficiently, while at the same time consistently improving MIL model performance. Experiments across multiple slide-level tasks and diverse organs show that HistAug outperforms existing methods, particularly in low-data regimes. Ablation studies confirm the benefits of learned transformations over noise-based perturbations and highlight the importance of uniform WSI-wise augmentation. Code is available at https://github.com/MICS-Lab/HistAug.

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