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Report on the AAPM grand challenge on deep generative modeling for learning medical image statistics

Abstract Background The findings of the 2023 AAPM Grand Challenge on Deep Generative Modeling for Learning Medical Image Statistics are reported in this Special Report. Purpose The goal of this challenge was to promote the development of deep generative models for medical imaging and to emphasize the need for their domain‐relevant assessments via the analysis of relevant image statistics. Methods As part of this Grand Challenge, a common training dataset and an evaluation procedure was developed for benchmarking deep generative models for medical image synthesis. To create the training dataset, an established 3D virtual breast phantom was adapted. The resulting dataset comprised about 108 000 images of size 512 512. For the evaluation of submissions to the Challenge, an ensemble of 10 000 DGM‐generated images from each submission was employed. The evaluation procedure consisted of two stages. In the first stage, a preliminary check for memorization and image quality (via the Fréchet Inception Distance [FID]) was performed. Submissions that passed the first stage were then evaluated for the reproducibility of image statistics corresponding to several feature families including texture, morphology, image moments, fractal statistics, and skeleton statistics. A summary measure in this feature space was employed to rank the submissions. Additional analyses of submissions was performed to assess DGM performance specific to individual feature families, the four classes in the training data, and also to identify various artifacts. Results Fifty‐eight submissions from 12 unique users were received for this Challenge. Out of these 12 submissions, 9 submissions passed the first stage of evaluation and were eligible for ranking. The top‐ranked submission employed a conditional latent diffusion model, whereas the joint runners‐up employed a generative adversarial network, followed by another network for image superresolution. In general, we observed that the overall ranking of the top 9 submissions according to our evaluation method (i) did not match the FID‐based ranking, and (ii) differed with respect to individual feature families. Another important finding from our additional analyses was that different DGMs demonstrated similar kinds of artifacts. Conclusions This Grand Challenge highlighted the need for domain‐specific evaluation to further DGM design as well as deployment. It also demonstrated that the specification of a DGM may differ depending on its intended use.

Radiology, Nuclear Medicine & Medical Imaging

Continuous-variable quantum Boltzmann machine

Here, we propose a continuous-variable quantum Boltzmann machine (CVQBM) using a powerful energy-based neural network. It can be realized experimentally on a continuous-variable (CV) photonic quantum computer. We used a CV quantum imaginary time evolution (QITE) algorithm to prepare the essential thermal state and then designed the CVQBM to proficiently generate continuous probability distributions. We applied our method to both classical and quantum data. Using real-world classical data, such as synthetic-aperture radar (SAR) images, we generated probability distributions. For quantum data, we used the output of CV quantum circuits. We obtained high fidelity and low Kullback–Leibler (KL) divergence showing that our CVQBM learns distributions from given data well and generates data sampling from that distribution efficiently. We also discussed the experimental feasibility of our proposed CVQBM. Our method can be applied to a wide range of real-world problems by choosing an appropriate target distribution (corresponding to, e.g., SAR images, medical images, and risk management in finance). Moreover, our CVQBM is versatile and could be programmed to perform tasks beyond generation, such as anomaly detection.

SAR images

Enhancing segmentation fairness through curriculum learning and progressive loss: a centralized and federated perspective on radiograph analysis

Bias in medical image segmentation can lead to unequal performance across demographic subgroups, raising concerns about fairness and reliability in clinical AI systems. While deep learning models have achieved high segmentation accuracy, ensuring equitable performance across race and gender remains a significant challenge, particularly in privacy-sensitive healthcare environments. This study investigates fairness-aware medical image segmentation for hip and knee radiographs using deep learning models evaluated in both centralized and Federated Learning (FL) settings. We introduce Curriculum Learning (CL) strategies and Progressive Loss (PL) functions to regulate sample difficulty during training. In addition, we propose two novel fairness-oriented federated learning algorithms, Federated Intersection over Union (FedIoU) and Federated Intersection over Union with Outlier Analysis (FedIoUoutlier). Experiments are conducted using multiple segmentation backbones and simulated multi-site data partitions derived from the Osteoarthritis Initiative dataset. Model performance is evaluated using Intersection over Union (IoU), IoU standard deviation, Skewed Error Ratio (SER), and Min-Max Disparity across race and gender subgroups. Statistical significance was verified using paired t-tests to compare per-sample IoU performance against baseline configurations. Across both hip and knee segmentation tasks, curriculum learning and progressive loss strategies consistently improved segmentation accuracy and reduced demographic performance disparities in centralized training. In federated settings, fairness-aware aggregation further enhanced performance. Notably, FedIoUoutlier combined with balanced curriculum learning and tiered progressive loss achieved the highest mean IoU while yielding the lowest SER and Min-Max Disparity, indicating improved fairness without sacrificing accuracy. In several configurations, federated models matched or exceeded the performance of optimized centralized models, with statistically significant improvements in per-sample IoU over baseline configurations. The results demonstrate that structured training strategies and fairness-aware federated aggregation can jointly improve accuracy, stability, and demographic fairness in medical image segmentation. By integrating curriculum learning, progressive loss, and novel FL algorithms, this work provides a practical pathway toward equitable and privacy-preserving AI systems for medical imaging.

97 MATHEMATICS AND COMPUTING

Reducing the Energy Consumption of Magnetic Resonance Imaging and Computed Tomography Scanners: Integrating Ecodesign and Sustainable Operations

This review aims to provide valuable insights into how energy consumption in magnetic resonance imaging (MRI) and computed tomography (CT) scanners can be effectively monitored, managed, and reduced, thereby contributing to more sustainable medical imaging practices. Demand for advanced imaging technologies such as MRI and CT scanners continues to increase, and understanding the resultant impact on greenhouse gas emissions requires a thorough evaluation of their energy consumption. Here, this review examines the energy monitoring and consumption characteristics of MRI and CT scanners, highlighting potential approaches for energy savings. An overview of MRI and CT principles, hardware components, and their associated energy consumption is provided. After addressing the technical aspects, the hardware and software requirements essential for accurate energy metering are detailed. Baseline measurements of energy consumption data are then provided as a foundation to understand current usage patterns and identify areas for improvement. Ongoing efforts to reduce energy consumption are categorized into 3 main strategies: operations, scanner design enhancements, and active scanning techniques, including accelerated MRI protocols. Ultimately, we emphasize that achieving sustainability in medical imaging requires collaboration across disciplines. By incorporating eco-friendly design in new imaging equipment, we can reduce the environmental impact, promote sustainability, and set a health care industry standard for a healthier planet.

62 RADIOLOGY AND NUCLEAR MEDICINE

AAPM Truth‐based CT (TrueCT) reconstruction grand challenge

Background: This Special Report summarizes the 2022, AAPM grand challenge on Truth-based CT image reconstruction. Purpose: To provide an objective framework for evaluating CT reconstruction methods using virtual imaging resources consisting of a library of simulated CT projection images of a population of human models with various diseases. Methods: Two hundred unique anthropomorphic, computational models were created with varied diseases consisting of 67 emphysema, 67 lung lesions, and 66 liver lesions. The organs were modeled based on clinical CT images of real patients. The emphysematous regions were modeled using segmentations from patient CT cases in the COPDGene Phase I dataset. For the lung and liver lesion cases, 1–6 malignant lesions were created and inserted into the human models, with lesion diameters ranging from 5.6 to 21.9 mm for lung lesions and 3.9 to 14.9 mm for liver lesions. The contrast defined between the liver lesions and liver parenchyma was 82 ± 12 HU, ranging from 50 to 110 HU. Similarly, the contrast between the lung lesions and the lung parenchyma was defined as 781 ± 11 HU, ranging from 725 to 805 HU. For the emphysematous regions, the defined HU values were −950 ± 17 HU ranging from −918 to −979 HU. The developed human models were imaged with a validated CT simulator. The resulting CT sinograms were shared with the participants. The participants reconstructed CT images from the sinograms and sent back their reconstructed images. Further, the reconstructed images were then scored by comparing the results against the corresponding ground truth values. The scores included both task-generic (root mean square error [RMSE] and structural similarity matrix [SSIM]), and task-specific (detectability index [d’] and lesion volume accuracy) metrics. For the cases with multiple lesions, the measured metric was averaged across all the lesions. To combine the metrics with each other, each metric was normalized to a range of 0 to 1 per disease type, with “0” and “1” being the worst and best measured values across all cases of the disease type for all received reconstructions. Results: The True-CT challenge attracted 52 participants, out of which 5 successfully completed the challenge and submitted the requested 200 reconstructions. Across all participants and disease types, SSIM absolute values ranged from 0.22 to 0.90, RMSE from 77.6 to 490.5 HU, d’ from 0.1 to 64.6, and volume accuracy ranged from 1.2 to 753.1 mm3. The overall scores demonstrated that participant “A” had the best performance in all categories, except for the metrics of d’ for lung lesions and RMSE for liver lesions. Participant “A” had an average normalized score of 0.41 ± 0.22, 0.48 ± 0.32, and 0.42 ± 0.33 for the emphysema, lung lesion, and liver lesion cases, respectively. Conclusions: The True-CT challenge successfully enabled objective assessment of CT reconstructions with the unique advantage of access to a diverse population of diseased human models with known ground truth. This study highlights the significant potential of virtual imaging trials in objective assessment of medical imaging technologies.

60 APPLIED LIFE SCIENCES

A Centralized AI Lakehouse Framework for Brain Tumor MRI Classification and Segmentation, University KPI Forecasting, and Water Potability Prediction

In many university and healthcare projects, models are built for very different data types such as tables, institutional time series, and medical images, but they are deployed as separate applications. In this work, that separation made testing and maintenance difficult because each module had its own pipeline and runtime requirements. This paper presents an integrated AI lakehouse-style implementation that runs three model pipelines inside one containerized backend. For medical imaging, we used MRI datasets from IEEE DataPort: a four-class classification set with 7012 images (5708 train/1304 test) and a segmentation set with 3063 image–mask pairs. The classification model (ResNet50 transfer learning) is evaluated using a proper train–validation–test protocol across multiple splits (80/10/10, 70/10/20, 60/10/30, and 10/30/60), achieving a test accuracy of 99.00% under the standard 80/10/10 split. Additionally, a patient-level evaluation is conducted using an external glioma dataset to provide a more realistic assessment without data leakage. The segmentation model (DeepLabV3-ResNet50) achieved 83.09% validation mIoU and 88.79% Dice score. For university KPI forecasting, we used annual IPEDS and NSF HERD data from 2010 to 2023 for three universities (BSU, EOU, and UAB). To examine the effect of preprocessing on forecasting performance, two case studies are conducted. In the first case, linear interpolation is applied to generate semester-level data. In the second case, the original annual data is used directly without interpolation. Random Forest regression and ARIMA models are evaluated using MAE, RMSE, MAPE, and R 2 . The results showed that interpolation improved apparent forecasting performance due to smoothing, while evaluation on the original annual data provided a more realistic assessment of model behavior. To further validate the framework on a larger dataset, an additional case study is conducted using a student dropout dataset. For water potability, we trained and compared multiple tabular classifiers on a large dataset (1,048,575 samples). A Random Forest model (100 trees, max depth 10) achieved 85.86% test accuracy and high recall for unsafe samples (0.8447). All modules are served via FastAPI and deployed together using Docker, with workflow automation routing requests to the correct endpoint. System-level benchmarking indicates that the backend maintains stable throughput and latency under concurrent requests.

97 MATHEMATICS AND COMPUTING

Simultaneous on-chip generation of violet, blue, cyan, green, yellow, orange, and red light from an octave-spanning infrared frequency comb

An integrated, multi-spectral visible-light source could significantly benefit technologies such as displays, medical imaging, spectroscopy, visible-light communications, and astrophysics. However, despite recent advances in chip-scale visible lasers, simultaneously generating light of all colors in a single chip has been challenging. Existing solutions are either not suitable for full chip-scale integration, or are fundamentally difficult to scale. Here we demonstrate the simultaneous on-chip generation of infrared, red, orange, yellow, green, cyan, blue, and violet light. Leveraging the low loss, low dispersion, and high density of modes of an adiabatic multimode silicon nitride (SiN) microresonator, we use a single infrared pump of moderate power (~130 mW) to produce an octave-spanning infrared frequency comb that is then converted to different portions of the visible spectrum. We measure non-mode-locked combs and soliton steps corresponding to mode-locked states, making our comb generator suitable for applications that demand either low or high coherence. Since the required pump power is compatible with high-power lasers demonstrated in the same SiN platform, our multi-octave light generator can be fully integrated in a chip-scale form factor. We envision that such a light source will be a catalyst for the development and deployment of miniaturized multi-spectral technologies for quantum systems, medical imaging, displays, and spectroscopy.

47 OTHER INSTRUMENTATION

An Overview of Emerging Nuclear Sensor Technologies: Challenges, Advancements and Applications

Nuclear sensors are essential for detecting and measuring nuclear radiation in various applications, including nuclear power plants, medical imaging, and environmental monitoring. Traditional nuclear sensors have served these fields for decades, but recent advancements in emerging sensor technologies offer novel improvements in accuracy, sensitivity, and reliability. This review presents an up-to-date overview of recent progress in the advancements of nuclear sensor technologies, their diverse applications, challenges in implementation, and opportunities for future research.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND

Multi-frequency progressive refinement for learned inverse scattering

Interpreting scattered acoustic and electromagnetic wave patterns is a computational task that enables remote imaging in a number of important applications, including medical imaging, geophysical exploration, sonar and radar detection, and nondestructive testing of materials. However, accurately and stably recovering an inhomogeneous medium from far-field scattered wave measurements is a computationally difficult problem, due to the nonlinear and non-local nature of the forward scattering process. We design a neural network, called Multi-Frequency Inverse Scattering Network (MFISNet), and a training method to approximate the inverse map from far-field scattered wave measurements at multiple frequencies. We consider three variants of MFISNet, with the strongest performing variant inspired by the recursive linearization method — a commonly used technique for stably inverting scattered wavefield data — that progressively refines the estimate with higher frequency content. MFISNet outperforms past methods in regimes with high-contrast, heterogeneous large objects, and inhomogeneous unknown backgrounds.

97 MATHEMATICS AND COMPUTING

SHF: Symmetrical Hierarchical Forest with Pretrained Vision Transformer Encoder for High-Resolution Medical Segmentation

This paper presents a novel approach to addressing the long-sequence problem in high-resolution medical images for Vision Transformers (ViTs). Using smaller patches as tokens can enhance ViT performance, but quadratically increases computation and memory requirements. Therefore, the common practice for applying ViTs to high-resolution images is either to: (a) employ complex sub-quadratic attention schemes or (b) use large to medium-sized patches and rely on additional mechanisms within the model to capture the spatial hierarchy of details. We propose Symmetrical Hierarchical Forest (SHF), a lightweight approach that adaptively patches the input image to increase token information density and encode hierarchical spatial structures into the input embedding. We then apply a reverse depatching scheme to the output embeddings of the transformer encoder, eliminating the need for convolution-based decoders. Unlike previous methods that modify attention mechanisms or use a complex hierarchy of interacting models, SHF can be retrofitted to any ViT model to allow it to learn the hierarchical structure of details in high-resolution images without requiring architectural changes. Experimental results demonstrate significant gains in computational efficiency and performance: on the PAIP WSI dataset, we achieved a 3∼32×speedup or a 2.95%∼7.03% increase in accuracy (measured by Dice score) at a 64K2 resolution with the same computational budget, compared to state-of-the-art production models. On the 3D medical datasets BTCV and KiTS, training was 6×faster, with accuracy gains of 6.93% and 5.9%, respectively, compared to models without SHF.

Zhang, Enzhi [Hokkaido University, Japan]

Domain Shift Analysis in Chest Radiographs Classification in a Veterans Healthcare Administration Population

This study aims to assess the impact of domain shift on chest X-ray classification accuracy and to analyze the influence of ground truth label quality and demographic factors such as age group, sex, and study year. We used a DenseNet121 model pre-trained MIMIC-CXR dataset for deep learning-based multi-label classification using ground truth labels from radiology reports extracted using the CheXpert and CheXbert Labeler. We compared the performance of the 14 chest X-ray labels on the MIMIC-CXR and Veterans Healthcare Administration chest X-ray dataset (VA-CXR). The validation of ground truth and the assessment of multi-label classification performance across various NLP extraction tools revealed that the VA-CXR dataset exhibited lower disagreement rates than the MIMIC-CXR datasets. Additionally, there were notable differences in AUC scores between models utilizing CheXpert and CheXbert. When evaluating multi-label classification performance across different datasets, minimal domain shift was observed in the unseen VA dataset, except for the label “Enlarged Cardiomediastinum.” The subgroup with the most significant variations in multi-label classification performance was study year. These findings underscore the importance of considering domain shift in chest X-ray classification tasks, paying particular attention to the temporality of the exam. Our study reveals the significant impact of domain shift and demographic factors on chest X-ray classification, emphasizing the need for improved transfer learning and robust model development. Addressing these challenges is crucial for advancing medical imaging research and improving patient care.

chest X-ray image classification

Window Cooling Studies and Disk Vibration Testing on a Subset of Mo-100 Disks

Production of metastable Technetium-99 (Tc-99m), a radioactive tracer that emits gamma rays, is vital to the medical imaging community. Tc-99m is extracted from the decay of Molybdenum-99 (Mo-99) which has a half-life of about 2-3 days. The work presented in this report is part of the NNSA’s mission to produce Mo-99 commercially, within the US, without the use of highly enriched uranium (HEU) in support of nonproliferation and global security. Los Alamos National Laboratory (LANL) is working with NorthStar Medical Radioisotopes (NMR) on their efforts to produce Mo-99 through the irradiation of Mo-100 targets using an electron beam. The NMR target comprises a stack of approximately 60-70 Mo-100 disks with diameter 24 mm and thickness 0.74 mm held in stainless steel laminations, each separated using 0.25 mm thick stainless-steel spacers. The symmetric target stack is housed in an Inconel vessel with two Inconel windows on either side. Two electron accelerators are used to produce 40 MeV, 3.16 µA electron beams each that penetrate the Inconel windows and irradiate the Mo-100 disks. Approximately 90% of the total 250 kW beam power is deposited in the NMR target during the irradiation process, with a smaller percentage adding up to 2.2 kW of heat deposited on the Inconel window. During irradiation, pressurized helium gas flows through thin gaps between the disks cooling the beam window, target disks, disk laminations and spacers. Both NMR and LANL have found during cold testing of the target system (no heat deposition) that the Mo 100 disks undergo significant mass loss and disk breakage due to vibrations induced by the flowing helium gas. The mass loss is not only undesirable due to monetary loss from reduced final quantities of Mo-99, but also due to the hazards associated with radioactive material trapped in the cooling lines and particle filters. The effect of flow rate and target geometry on the flow induced vibrations need to be quantified, and recommendations provided to minimize this mass loss. LANL has previously also tested NMR’s Inconel beam window by heating the window, while flowing pressurized helium, using the average heat deposited on the window. However, the NMR beam is pulsed with a duty cycle of 12.5%, which introduces oscillation in temperature around the nominal 600 °C steady state value with each pulse. Available fatigue curves for Inconel are few, established for room temperature, and they are based on mechanical strain cycles not thermally induced strain as in the NMR target. The effect of pulsed beam heating on the Inconel window therefore needs to be quantified. This report details the experiments conducted to assess the factors that lead to mass loss in the NMR target disks as well as to understand the effect of a pulsed beam on NMR’s Inconel window. This work describes LANL’s experimental characterization of the flow induced vibrations and disk mass loss in a reduced scale set-up containing 5 to 10 Mo-100 disks. We use high speed imaging, displacement measurements and microphone measurements combined with signal processing to estimate the vibration frequency of each disk. The effect of disk thickness, target fit and duration of testing on the mass loss is described. We find that in the current configuration of NMR targets, the vibrations and mass loss on the first disk are minimized, while those in the adjacent disks are highest. The microphone and high-speed image data show that increased flow rates and increased duration of testing increases vibration frequency and mass loss. The mass loss is due to both disk rotation and back and forth motion. There are visible wear marks on the disks with the highest mass loss. We also note that the current NMR window gap reduces flow induced vibrations compared to the previous smaller gaps. Improved target holders significantly reduce disk mass loss to almost negligible quantities. This work finds that the larger window to first disk gap and improved target holder geometry should allow NMR to successfully conduct irradiations with minimal mass loss. The window tests were conducted to understand the effect of a pulsed beam on both the window longevity and to estimate the window temperature and displacement during pulsing. The experiments presented here were performed at significantly low power, due to the limitations of the induction heating system. The window temperature rose to approximately 73 °C with a significantly reduced power of 45 W without beam pulsing. With a 5 Hz pulse rate, 12.5% duty cycle, the window temperature remained constant at 26 °C. These experiments will be repeated with improved coil geometry and reported in upcoming journal papers.

42 ENGINEERING

Gain characterization of LGAD sensors with beta particles and 28-MeV protons

Low Gain Avalanche Diodes, also known as LGADs, are widely considered for fast-timing applications in high energy physics, nuclear physics, space science, medical imaging, and precision measurements of rare processes. Such devices are silicon-based and feature an intrinsic gain due to a p + -doped layer that allows the production of a controlled avalanche of carriers, with multiplication on the order of 10–100. This technology can provide time resolution on the order of 20–30 ps, and variants of this technology can provide precision tracking too. The characterization of LGAD performance has so far primarily been focused on the interaction of minimum ionizing particles for high energy and nuclear physics applications. This article expands the study of LGAD performance to highly-ionizing particles, such as 28-MeV protons, which are relevant for several future scientific applications, e.g. in biology and medical physics, among others. These studies were performed with a beam of 28-MeV protons from a tandem Van de Graaff accelerator at Brookhaven National Laboratory and beta particles from a ^90Sr source; these were used to characterize the response and the gain of an LGAD as a function of bias voltage and collected charge. Here, the experimental results are also compared to TCAD simulations.

47 OTHER INSTRUMENTATION

Scale-up Unlearnable Examples Learning with High-performance Computing

Recent advancements in AI models, like ChatGPT, are structured to retain user interactions, which could inadvertently include sensitive healthcare data. In the healthcare field, particularly when radiologists use AI-driven diagnostic tools hosted on online platforms, there is a risk that medical imaging data may be repurposed for future AI training without explicit consent, spotlighting critical privacy and intellectual property concerns around healthcare data usage. Addressing these privacy challenges, a novel approach known as Unlearnable Examples (UEs) has been introduced, aiming to make data unlearnable to deep learning models. A prominent method within this area, called Unlearnable Clustering (UC), has shown improved UE performance with larger batch sizes but was previously limited by computational resources (e.g., a single workstation). To push the boundaries of UE performance with theoretically unlimited resources, we scaled up UC learning across various datasets using Distributed Data Parallel (DDP) training on the Summit supercomputer. Our goal was to examine UE efficacy at high-performance computing (HPC) levels to prevent unauthorized learning and enhance data security, particularly exploring the impact of batch size on UE’s unlearnability. Utilizing the robust computational capabilities of the Summit, extensive experiments were conducted on diverse datasets such as Pets, MedMNist, Flowers, and Flowers102. Our findings reveal that both overly large and overly small batch sizes can lead to performance instability and affect accuracy. However, the relationship between batch size and unlearnability varied across datasets, highlighting the necessity for tailored batch size strategies to achieve optimal data protection. The use of Summit’s high-performance GPUs, along with the efficiency of the DDP framework, facilitated rapid updates of model parameters and consistent training across nodes. Our results underscore the critical role of selecting appropriate batch sizes based on the specific characteristics of each dataset to prevent learning and ensure data security in deep learning applications. The source code is publicly available at https: // github. com/ hrlblab/ UE_ HPC .

Zhu, Yanfan [Vanderbilt University, Nashville, TN,

Ionic Liquid Aided [ 11 C]CO Fixation for Synthesis of 11 C‐carbonyls

Tributyl(ethyl)phosphonium oxopentenolate ([P 4442 ][Pen]) is an ionic liquid developed to capture CO and has shown ability to catalyze carbonylation reactions in organic chemistry. Carbon-11 ( 11 C, t 1/2 =20.4 min) labeled CO is a highly versatile building block for the synthesis of positron emission tomography (PET) radiotracers that are applied for medical imaging. The use of [ 11 C]CO is limited by its low solubility in organic solvents. Herein, we report a proof-of-concept study evaluating a new method to prepare 11 C-labeled amides, ureas and carbamates via reaction of [ 11 C]CO in [P 4442 ][Pen] and applied for fully automated radiosyntheses of Bruton's tyrosine kinase inhibitors, [ 11 C]evobrutinib and [ 11 C]ibrutinib.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH