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Accurate Reconstruction of Gas Turbine Blade Geometry Using 3D/2D Rigid Registration and CT View Optimization

Non-destructive X-ray and computed tomography (CT) testing are essential for ensuring the dimensional accuracy of manufactured components with complex internal structures, such as the cooling channels in gas turbine blades, which directly affect thermal performance and service life. This study presents a multipart 3D-2D rigid registration approach for aligning CAD models with X-ray projections as an alternative to CT reconstruction for part inspection and measurement. A greedy registration algorithm sequentially aligns the blade's exterior before registering its internal components by maximizing the mutual information between simulated and acquired X-ray images. This stepwise approach reduces problem complexity and improves alignment accuracy. View angles are optimized using a greedy method that iteratively selects angles to minimize dimensional measurement errors. The results indicate that a small number of oblique views provides the best accuracy, although a broad range of angles yields acceptable results. The method achieves subpixel registration accuracy, with errors below one-fifth of the magnified detector-pixel pitch. Image noise and defects reduce registration precision, but direct registration in projection space mitigates these effects compared with CT reconstruction. Appropriate view selection can therefore preserve acceptable subpixel accuracy in the presence of image noise and defects.

cs.CV

CT-$Δ$Bench: A Benchmark for Longitudinal 3D Medical Imaging Difference Reporting with Vision-Language Models

In medical imaging, the clinical value of Computed Tomography (CT) lies not only in depicting current disease status, but crucially in enabling longitudinal comparison of serial scans to determine disease evolution, a process that underpins response assessment, recurrence detection, and ongoing patient management. Yet, despite this central role of temporal comparison in clinical decision-making, existing medical foundation models remain largely confined to single-study understanding, leaving temporally grounded cross-examination insufficiently addressed. To address this gap, we study longitudinal imaging difference reporting, a task in which a model takes two temporally separated scans from the same patient and generates a clinically meaningful report describing interval changes between them. We introduce CT-$Δ$Bench, a dedicated benchmark for this task with patient-level splitting to prevent information leakage. To better evaluate this task beyond surface-level text similarity, we further develop change-aware metrics specifically designed to capture clinically meaningful longitudinal changes, and conduct an independent physician validation to assess the reliability of the synthesized references and event extraction pipeline. We also compare direct paired-CT reasoning with an indirect two-stage pipeline that first generates single-timepoint reports and then performs textual differencing. Finally, we propose DeltaMed, a baseline model for direct paired-CT difference reporting, and train it on the benchmark training set. Together, these contributions lay the groundwork for temporally aware medical foundation models that better reflect real-world longitudinal clinical reasoning.

cs.CL

EPC-3D-Diff: Equivariant Physics Consistent Conditional 3D Latent Diffusion for CBCT to CT Synthesis

Cone-beam CT (CBCT) is routinely acquired during radiotherapy for patient setup, but its quantitative reliability is degraded by scatter, noise, and reconstruction artifacts, limiting Hounsfield Unit (HU) accuracy. We propose EPC-3D-Diff, a novel conditional 3D latent diffusion framework for volumetric CBCT to CT synthesis that introduces a projection domain equivariance loss derived from acquisition physics. Unlike common image domain equivariance, we exploit the fact that an in plane rotation of the volume corresponds to an angular shift in its projections. During training, we enforce this relationship by forward projecting rotated synthesized CT volumes and matching them to appropriately angle shifted projections of the paired target CT, yielding a physics consistent equivariance constraint integrated into the diffusion objective. To capture full 3D context efficiently, conditional diffusion is performed in a compact latent space learnt by a lightweight 3D autoencoder, preserving axial depth while downsampling in plane resolution for stable training. We validate on a paired head CBCT/CT phantom dataset, including repeat scans, and paired clinical data using patient wise splits, and perform single and mixed domain training, ablations, and comparisons with diffusion and CycleGAN. EPC-3D-Diff generalizes well and achieved substantial improvements, +7.4 dB (phantom) and +1.8 dB (clinical data) in PSNR compared to state of the art methods, alongside improved SSIM and HU accuracy, within tissue boundaries. Overall, EPC-3D-Diff improves robustness and physics consistency, supporting HU aware synthesis for downstream radiotherapy workflows. The open source code for EPC-3D-Diff is available at https://github.com/ALZAHRAALTALIB/EPC-3D-Diff.

cs.CV

Weakly-supervised Kidney Tumor Classification from CT Scans with Multi-Instance Learning and Anatomical Filtering

Deep learning models for CT scan analysis are often limited by the scarcity of precise pixel-level annotations, which require significant radiologist effort to produce. Training on scan-level labels alone reduces annotation requirements but introduces challenges: low supervision ratios and large input volumes make models prone to overfitting and shortcut learning. In this work, we investigate two complementary methods to address these challenges: multi-instance learning (MIL) and anatomical filtering. MIL divides CT volumes into 2D slice instances, enabling efficient 2D architectures with ImageNet pretraining rather than computationally demanding 3D models. Anatomical filtering uses Compass, our self-supervised body part regression model, to crop scans to pathology-relevant subregions without requiring segmentation masks. We evaluate two MIL frameworks - Attention-based MIL (ABMIL) and FocusMIL - on kidney tumor classification across one internal dataset (TUH) and two external datasets (KiTS23 and TCGA-KiRC). Our best models achieve F1 = 0.83 on the internal test set using only scan-level labels. We further show that anatomical filtering with the Compass model is critical for the out-of-distribution generalization of embedding-based ABMIL, while instance-based FocusMIL demonstrates greater inherent robustness to distribution shift. While evaluated on kidney tumors, we consider this a proof-of-concept for a broader weakly supervised CT classification pipeline applicable to other organs and pathologies.

cs.CV

CARDINAL Predicts Cardiovascular Risk From Non-contrast Cardiac CT

Cardiovascular risk prediction remains limited by incomplete clinical data and imaging biomarkers that reduce computed tomography (CT) to a small number of handcrafted features. We developed CARDINAL (Cardiovascular Assessment via Representation learning from Deep Imaging with Nested Anatomical Latent embeddings), a clinically grounded framework that learns compact representations from routine non-contrast cardiac CT for major adverse cardiovascular event (MACE) prediction. In 17,659 patients, CARDINAL was evaluated for 1-, 3-, 5-, and 10-year MACE prediction against American Heart Association (AHA) pooled cohort equations (PCE), AHA predicting risk of cardiovascular disease events (PREVENT), coronary artery calcium (CAC), segmentation-derived CT biomarkers, and 70-feature structural radiomics. Gains were largest at longer horizons. At 10 years, CARDINAL (joint) achieved an area under the receiver operating characteristic curve (AUROC) of 0.866 $\pm$ 0.020 and an area under the precision-recall curve (AUPRC) of 0.890 $\pm$ 0.015, compared with an AUROC of 0.826 $\pm$ 0.023 and an AUPRC of 0.826 $\pm$ 0.022 for structural radiomics, the strongest baseline. CARDINAL also achieved the highest survival concordance index (C-index), 0.753 $\pm$ 0.015, and high-versus-low risk-tertile hazard ratio, 10.78 $\pm$ 3.16, with favorable reclassification and exploratory calibration. These findings suggest that non-contrast cardiac CT contains prognostic information beyond conventional risk equations, CAC scoring, and engineered imaging biomarkers.

eess.IV

Error Detection for PET/CT Radiology Reports: Domain-Specific vs Large Language Models

Errors in radiology reports can adversely affect patient treatment, yet automated report quality assurance remains challenging because errors are often subtle and require domain expertise to detect. Although large language models (LLMs) have recently been proposed for radiology report verification, their ability to detect clinically meaningful errors beyond chest X-ray datasets remains under-explored. To this end, we present the first systematic evaluation of language models for PET/CT report error detection, comparing compact domain-specific models with SOTA open-weight LLMs. We collected 30,633 oncology FDG PET/CT reports from 23 radiologists over 10 years. We trained domain-specific BERT models to detect clinically motivated synthetic reporting errors and evaluated alongside zero-/few-shot Qwen3-32B, Gemma-3-27B and Llama-3.3-70B on a held-out benchmark of 11,500 reports. A 15M-parameter model achieved 94.4% balanced accuracy with a 5.8% false-positive rate, compared with 84.0% for the strongest prompted LLM. Task-specific adaptation of Llama-3.3-70B closed this performance gap (94.4%) but retained substantially greater computational requirements. Our results suggest that domain-specific training matters more than model scale for PET/CT report error detection, supporting compact models as an accurate and computationally efficient approach to automated radiology report quality assurance.

cs.LG

BS: Take the Hint - Interactive Multitracer PET/CT Lesion Segmentation with a Scribble-Conditioned ResEnc U-Net

Automated lesion segmentation in whole-body PET/CT is complicated by the variety of physiological tracer uptake patterns and by the differing appearance of lesions across tracers. The autoPET/CT V challenge addresses this by making segmentation interactive: user scribbles marking foreground and background are supplied alongside the image, and the algorithm is expected to exploit them. We present our submission, a scribble-conditioned residual encoder U-Net operating on four input channels: CT, PET, and a sparse scribble map for each of foreground and background. The network is initialised from the autoPET-III winning weights and extended from two to four input channels, with the two scribble channels zero-initialised so that the pretrained representation is preserved exactly at initialisation. Every model is fine-tuned per fold from the corresponding autoPET-III fold checkpoint, so that no validation case is seen during pretraining. PET intensities are normalised against a per-scan aorta blood-pool reference derived from a CT segmentation, which removes tracer- and centre-specific scaling without requiring lesion labels. At inference the five fold models are ensembled by averaging their softmax outputs per sliding-window patch, before Gaussian-weighted stitching. On the challenge's five-fold split, with each fold evaluated on its own validation cases, mean Dice is 0.554 and mean lesion-level F1 is 0.528 without scribbles, rising to 0.751 and 0.733 after five correction rounds. About 85% of that gain follows the first scribble, and the spread between fold models narrows five-fold over the same rounds, so interaction largely compensates for how well or badly a given model segments unaided.

cs.CV

Automated Chest CT Protocol Selection via Large Language Model Derived Text Embeddings from Imaging Request Text

Purpose: Accurate CT protocol selection is critical for diagnostic quality and patient safety, yet the current process is manual, time-consuming, and prone to inconsistencies. Prior Machine Learning methods using keywords or bag-of-words lack contextual understanding and perform poorly on rare protocols. We propose a decision support system using large language model (LLM) features to recommend protocols from free-text clinical indications, capturing clinical nuance and phrasing variation for more consistent, efficient selection. Methods: In this REB-approved retrospective study, 285,123 chest CT imaging requests from a large academic medical center (2017-2024) were split into training (228,099, 80%) and held-out test (57,024, 20%) sets. Each request included procedure names, clinical indication, HIS comments, and the selected protocol. Clinical text was embedded using a fine-tuned LLM, Meta's LLaMA-3.1-70B; these features input a logistic regression classifier predicting 18 protocol labels (e.g., PE, LDCT). Results: The pipeline achieved a weighted precision of 0.84, weighted F1-score of 0.81, and overall accuracy of 79% across 18 CT protocols. On 300 independent cases with expert consensus, the LLM reached an overall accuracy of 80% versus 83% for radiologists, with no significant difference (p = 0.263). Performance was comparable across most classes, with the LLM exceeding radiologists for some challenging categories, and entropy analyses indicated more balanced protocol use, suggesting reduced variability. Conclusion: An LLM-based recommendation system can leverage general knowledge from a large natural-text corpus to accurately assign chest CT protocols from free-text imaging requests, and may serve as a viable foundation for protocol recommendation tools where inputs require language understanding.

cs.LG

Physics-Driven Independent Pair Generation for Iterative Self-Supervised Low-Dose CT Denoising

Low-dose computed tomography (LDCT) measurements contain mixed Poisson-Gaussian noise. However, most self-supervised methods rely on generic image statistics and do not explicitly model this noise, which may limit their ability to effectively suppress realistic LDCT noise. To address this issue, we propose a physics-driven framework with cross-domain iteration for self-supervised LDCT denoising. The proposed framework proceeds in three main steps. First, a learned sinogram prior and the LDCT noise model guide posterior inference of photon counts, enabling separation of the Poisson and Gaussian components. Second, the separated Poisson and Gaussian components are respectively processed by binomial thinning and Gaussian data thinning to construct two branches, and residual scaling matches each branch's noise level to that of the observation, yielding a training pair with approximately independent noise realizations from one low-dose measurement. Finally, the pair is used to train an image-domain network whose forward-projected outputs update the prior. Through cross-domain iteration, the prior and the training pair are progressively refined while maintaining consistency with CT acquisition physics. Experiments on simulated data from AAPM, LIDC-IDRI, and LoDoPaB-CT and on real LDCT data show consistent gains over the evaluated self-supervised baselines across dose levels, with performance comparable to the evaluated supervised baseline.

cs.CV

$K$-NeAS: Scalable Multi-Material CT Reconstruction Using Neural SDFs

Computed Tomography (CT) carries significant ionizing radiation risks, driving the need for sparse-view reconstruction. Implicit scene representations (ISRs) address this by recovering continuous volumetric attenuation fields directly from sparse projections, and recent geometry-aware extensions jointly model surface geometry alongside attenuation to improve fidelity and enable clean tissue segmentation without manual thresholding. However, these methods remain limited by manually tuned attenuation bounds and rigid two-material constraints. This paper proposes $K$-NeAS, a unified and scalable architecture for automated, multi-material surface reconstruction. We replace independent material networks with a shared latent backbone and introduce a fully differentiable $K$-material sequential soft selector to model an arbitrary number of overlapping tissues. To eliminate manual tuning, we automate attenuation bounding using a Gaussian Mixture Model (GMM) and implement a scheduled auxiliary floater loss to mitigate geometric hallucinations common under extreme sparsity. Evaluated across four clinical Cone-Beam CT (CBCT) datasets, $K$-NeAS successfully scales to arbitrary material counts, achieving superior 3D volumetric fidelity at $K=3$ materials on complex multi-tissue regions such as the Abdomen ($33.28\text{ dB}$ 3D PSNR vs. $31.40\text{ dB}$ single-material NeAS baseline, a $+1.88\text{ dB}$ improvement). Furthermore, our model exhibits enhanced robustness under sparse-sampling conditions, outperforming baseline 3D PSNR by up to $1.17\text{ dB}$ under 5- and 10-view constraints.

cs.CV

A Specialized Large Multimodal Model for Interpreting PET/CT in Head and Neck Cancer

Background: Diagnosing head and neck cancer using PET/CT is clinically challenging and time-consuming due to the anatomical complexity of the region, motivating computer-aided diagnosis (CAD). Generalist Large Multimodal Models (LMMs) remain limited in medical contexts by insufficient domain-specific knowledge, privacy and security concerns, and verbosity, motivating specialized standalone LMMs. Purpose: We evaluated the feasibility of a specialized LMM for automated PET/CT interpretation in head and neck cancer using a large-scale multi-institutional PET/CT dataset, a tailored training curriculum, and autoregressive training. Methods: LLaVA-NeXT was fine-tuned using a two-level curriculum with image-conversation pairs curated by two radiologists from public data. The dataset included clinically important annotations such as primary tumor presence and metastatic lymph node location. Level 1 used 28,000 image-conversation pairs to learn basic information, including modality type and hypermetabolism. Level 2 used 12,975 pairs to learn primary tumor presence and the existence and anatomical location of cervical lymph node metastases. External validation included four institutions with diverse imaging devices. Results: The specialized LMM substantially outperformed ChatGPT and LLaVA-NeXT. In Level-2 external validation, ROUGE-L, ROUGE-S, Cosine Similarity, Precision, Recall, and F1 were 0.8751, 0.8794, 0.8324, 0.8794, 0.8711, and 0.8751, while generalist models consistently scored below 0.1. Primary tumor classification accuracy was 83.14 +/- 1.15% internally and 69.03 +/- 0.81% externally. For lymph node localization, the corresponding scores were 0.6389, 0.6257, 0.5287, 0.5782, 0.6371, and 0.6648. Conclusion: Specialized LMMs show promising results for fast, accurate PET/CT-based diagnostic support and medical education, highlighting their potential for clinical translation.

cs.CV

Conditional Diffusion for 3D CT Volume Reconstruction from 2D X-rays

Computed tomography (CT) provides rich 3D anatomical detail but is often constrained by high radiation exposure, substantial costs, and limited availability. Standard chest X-rays are cost-effective and widely accessible, but provide only 2D projections with limited pathological information. Reconstructing 3D CT volumes from 2D X-rays could markedly increase diagnostic accessibility, yet existing methods rely predominantly on synthetic X-ray projections, limiting clinical generalization. We propose AXON, a multi-stage diffusion-based framework that reconstructs 3D CT volumes directly from real X-rays with substantially improved fidelity over existing approaches. AXON follows a coarse-to-fine paradigm: a Brownian Bridge diffusion model first captures global anatomical structure, and a ControlNet-guided refinement stage then enhances local intensity detail and anatomical realism. To alleviate the depth ambiguity inherent in 2D-to-3D reconstruction, AXON incorporates bi-planar X-ray views, enabling more accurate spatial reasoning and structural recovery. A dedicated super-resolution module further increases the spatial resolution of the generated volumes. Experiments on public and external datasets show that AXON consistently surpasses state-of-the-art approaches while generalizing across diverse clinical distributions. At our highest-resolution bi-planar setting, AXON achieves an 11.9% improvement in PSNR and an 11.0% increase in SSIM over the strongest baseline evaluated at that resolution. In the $128^3$ single-planar setting, it maintains a lead of 7.8% in PSNR on LIDC-IDRI, with larger margins on the external clinical dataset of 8.0% in PSNR and 16.9% in SSIM. Our code is available at https://github.com/ai-med/AXON/.

cs.CV

Deep Learning-Based Segmentation of Peritoneal Cancer Index Regions from CT Imaging

Peritoneal metastases (PM) are staged using the surgically determined Peritoneal Cancer Index (sPCI), which requires invasive laparoscopic assessment. Although CT is routinely used for preoperative evaluation, imaging-based assessment of PM extent remains challenging and is often less structured than surgical PCI scoring. A recent consensus study defined radiological PCI (rPCI) regions for cross-sectional imaging. We present the first deep learning approach to automatically segment 13 rPCI regions on CT. 62 contrast-enhanced CT scans were retrospectively collected across the full PCI range. Each scan was annotated into non-overlapping rPCI regions by one researcher, reviewed by a second, with disagreements resolved by a radiologist. Using five-fold cross-validation, we compared nnU-Net and Swin UNETR with Dice, 95th-percentile Hausdorff distance (HD95) and Average Surface Distance (ASD). We introduce an anatomically constrained pipeline that trains on merged super-regions and splits them during post-processing using TotalSegmentator landmarks at the hips and the ligament of Treitz. On this 62-scan cohort, the baseline nnU-Net reached an overall Dice of 0.81 and outperformed Swin UNETR (0.76). The proposed pipeline improved the overall Dice to 0.84 and reduced boundary error (HD95 13.7 to 11.8 mm; ASD 4.1 to 3.4 mm), with the largest gains in the small-bowel regions, approaching the interobserver Dice of 0.87. Automated rPCI region segmentation on CT is feasible and approaches interobserver agreement. Encoding anatomical boundary constraints substantially improves segmentation quality in the most challenging regions. This provides a reproducible foundation for non-invasive, imaging-based PCI assessment. The main limitations are the single-center cohort and the small interobserver subset.

cs.CV

FoundDiff: Foundational Diffusion Model for Generalizable Low-Dose CT Denoising

Low-dose computed tomography (CT) denoising is crucial for reduced radiation exposure while ensuring diagnostically acceptable image quality. Despite significant advancements driven by deep learning (DL) in recent years, existing DL-based methods, typically trained on a specific dose level and anatomical region, struggle to handle diverse noise characteristics and anatomical heterogeneity during varied scanning conditions, limiting their generalizability and robustness in clinical scenarios. In this paper, we propose FoundDiff, a foundational diffusion model for unified and generalizable LDCT denoising across various dose levels and anatomical regions. FoundDiff employs a two-stage strategy: (i) dose-anatomy perception and (ii) adaptive denoising. First, we develop a dose- and anatomy-aware contrastive language-image pre-training model (DA-CLIP) to achieve robust dose and anatomy perception by leveraging specialized contrastive learning strategies to learn continuous representations that quantify ordinal dose variations and identify salient anatomical regions. Second, we design a dose- and anatomy-aware diffusion model (DA-Diff) to perform adaptive and generalizable denoising by synergistically integrating the learned dose and anatomy embeddings from DA-CLIP into diffusion process via a novel dose and anatomy conditional block (DACB) based on Mamba. Extensive experiments on a large simulated multi-dose CT dataset spanning three anatomical regions, together with cross-dataset evaluations on Mayo-2016, CQ500, and piglet datasets, demonstrate superior denoising performance and strong generalization to unseen dose levels and anatomical regions. The codes and models are available at https: //github.com/hao1635/FoundDiff.

cs.CV

Prompt-Guided Interactive Segmentation of Interstitial Lung Disease in Thoracic CT

Accurate segmentation of interstitial lung disease (ILD) patterns is essential for quantitative disease assessment and longitudinal monitoring. However, existing approaches remain limited by relying on dense annotations and producing static predictions that cannot be refined, motivating interactive approaches. While promptable models show promise in interactive segmentation, their adaptation to ILDs remains largely unexplored. To address this gap, we investigate prompt-guided foundation models for ILD refinement and present, to the best of our knowledge, the first adaptation of MedSAM2 for interactive 3D ILD segmentation on thoracic CT. We investigate three fine-tuning strategies and multiple clinically motivated prompts: bounding-boxes (BBox), point, lasso, and scribble. On a dataset spanning seven ILD patterns and healthy lung tissue, full model fine-tuning performed best, improving the average Dice score by 4.7 percentage points over MedSAM2.While BBox prompts achieve the strongest performance, non-native MedSAM2 interactions such as lasso and scribble prompts also prove effective. Finally, we present and evaluate a proof-of-concept end-to-end workflow in which MedSAM2 is initialized from an automatic segmentation prior and subsequently refined using radiologist prompts. Model weights and plug-ins made available at: https://github.com/AIHNlab/ILD-SemiSegTool.

cs.CV

ImageCAS-X: a dataset and benchmark for coronary artery segmentation and centerline extraction in coronary CT angiography

Accurate segmentation of the coronary vessel lumen is a prerequisite for quantitative assessment of atherosclerotic plaque and perivascular adipose tissue in coronary computed tomography angiography (CCTA). Cardiologists rely on semi-automated methods for this task because manual vessel tracing and segmentation are labour-intensive. Although many automated methods have been proposed, their validation remains limited by the lack of large, high-quality publicly available datasets. We provide a new dataset of voxel-wise annotations of the vessel lumen and coronary segments, alongside centerlines, and mesh surfaces for 800 scans from the publicly available ImageCAS dataset. Using this dataset, we benchmark established lumen segmentation methods against inter-observer variability, stratifying performance by disease, image quality, coronary dominance, coronary segment, vessel diameter, and lumen attenuation. These labels allow segmentation accuracy to be described in anatomical and clinical context rather than reported as a single aggregate score. The dataset supports the development and validation of methods for lumen segmentation, plaque and perivascular quantification, and haemodynamic modelling.

cs.CV

Instance-Guided Report Anchoring for Text-Free 3D Abnormality Segmentation in Chest CT

Accurate 3D abnormality segmentation in chest CT requires dense spatial supervision, but obtaining expert voxel-level labels is costly. Radiology reports, however, are routinely generated during clinical interpretation and contain instance-specific descriptions that can provide additional guidance without new dense annotation. Existing vision-language grounding methods typically require report-derived findings at inference, making localization dependent on paired text and limiting each forward pass to a queried finding. We propose Instance-Guided Report Anchoring (IGRA), a model-agnostic module that preserves the correspondence between each annotated abnormality instance and the report finding that describes it. IGRA pools each instance representation and anchors it to the corresponding finding embedding during training; all text-related components are discarded at inference. We further reformulate free-text grounding on ReXGroundingCT as multi-label volumetric segmentation by merging same-category instances, allowing all abnormality categories to be predicted in one image-only forward pass. IGRA improves Dice by 22.5% over the strongest image-only baseline (30.93 vs. 25.25) and is comparable to VoxTell on the single-finding subset (30.29 vs. 30.43). Applied unchanged to four standard 3D segmentation backbones, IGRA improves Dice and hit rate across all architectures. Zero-shot evaluation on LIDC-IDRI, PleThora, and a private in-house dataset further shows consistent gains over image-only baselines.

cs.CV

BEAM3R: Beam's-eye-view architecture with Mamba-3 for implicit dose reconstruction

To enable accurate and rapid photon control point and proton beamlet dose calculation in the DoseRAD2026 challenge, we present BEAM3R, a dose estimation framework operating in beam's-eye-view (BEV). Our core innovation combines a Mamba-3 state-space depth-sequence core with physics-based transport conditioning to model long-range depth transport without expensive 3D convolutions. BEAM3R shares a 2D CNN encoder-decoder architecture for photon and proton dose tasks, processing per-plane BEV slices. Proton beamlets are conditioned on water equivalent thickness and remaining range, encoding the parameters determining Bragg peak position. Photon models use a bidirectional Mamba-3 core to capture dose contributions from materials downstream of the calculation point, while the proton model uses a forward core with learned energy-prefix tokens and a Bragg-peak refinement module. To reduce interpolation artifacts and support high spatial resolution, we introduce axial grid alignment of BEV lattices with CT slices and an implicit super-resolution representation via sub-pixel phase packing, evaluated by a differentiable Triton-accelerated resampler that reconstructs packed cubic B-spline coefficients directly in CT space. For MRI-based tasks, synthetic CTs (sCT) are generated by a patch-based conditional GAN with a SwinUNETR backbone. On the preliminary DoseRAD2026 test set, CT-to-photon and CT-to-proton models achieved 1%/1 mm local gamma pass rates of 96.8% and 96.0%, with stratified plan-level MAEs of 0.0041 and 0.0079. Substituting sCT reduced gamma pass rates to 89.7% for photon and 75.4% proton plan level doses, with stratified plan-level MAEs of 0.0093 and 0.0336. Standardised runtimes were 23.4 s and 18.4 s for CT-to-photon and CT-to-proton prediction, increasing to 39.7 s and 42.8 s for the corresponding MRI-based pipelines.

physics.med-ph