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arXiv2026

Evaluating the Effects of Inter-Observer and Model Variability on Radiological Peritoneal Cancer Index Assessment

Deep learning segmentation models are often evaluated using geometric metrics such as Dice, HD95, and ASD, yet it remains unclear to what extent improvements in these metrics translate into clinically meaningful changes in downstream decision-making. The metric-to-decision gap is examined using radiological Peritoneal Cancer Index (rPCI) region segmentation on contrast-enhanced CT, where a consensus definition provides anatomically grounded 3D regions and the clinically used PCI 20 threshold enables decision-level evaluation. Inter-observer variability is quantified across four experts on ten abdominal CT scans, and a published nnU-Net based rPCI segmentation model is benchmarked against this human reference using Dice, HD95, and ASD across all 13 regions. To relate geometric differences to clinical impact, a probabilistic peritoneal metastasis simulation is implemented on majority-vote rPCI maps, propagating region-boundary variability into variability of derived (r)PCI scores and classification at the PCI 20 cutoff. Observers showed high agreement (mean Dice $0.87$), while the model matched human performance in most regions but deviated more in regions 4, 8, and the small-bowel regions (9-12). Across simulations, score differences were typically small (mean $Δ$rPCI $\approx 0.3$-$0.6$) for both observers and the model, and decision flips occurred predominantly when the reference score was near 20. These results suggest that rPCI-derived scoring is generally robust to typical segmentation variability, while highlighting borderline cases as the main setting where expert review remains essential.

eess.IV↗
arXiv2026

Data-Efficient Networks for Multi-Contrast MRI Reconstruction based on a Generalized Content/Style Prior

Multi-contrast MR scans contain redundant structural information that can be leveraged during reconstruction and potentially accelerate acquisition times. This idea has inspired end-to-end guided reconstruction models, leveraging one or more contrasts to guide the reconstruction of a different contrast. However, these models require large paired multi-contrast raw datasets for training, limiting their application in low-data regimes. In this work, we propose a modular framework, namely CoSMo-RecNet, for learning guided reconstruction models in the low-data regime. At its core is a reusable multi-contrast representation based on a content/style model, which can be learned from large-scale, publicly accessible, unpaired multi-contrast image datasets, without available k-space data. Using this frozen model as a multi-contrast prior and using a set of reference contrasts, the reconstruction problem reduces to a much simpler refinement problem that can be solved by a lightweight unrolled network and thus learned from small, task-specific reconstruction datasets. We demonstrate the efficacy of CoSMo-RecNet by evaluating it on the low-field 0.3 T M4Raw dataset, showing stable reconstruction quality on decreasing the raw training data budget. CoSMo-RecNet achieved higher reconstruction quality with 5 training subjects or lower compared to a parameter-count-matched MoDL trained on 100 subjects. On a data-limited and severely out-of-distribution ultra-low-field 47 mT Halbach scanner dataset, CoSMo-RecNet was superior to other viable strategies, including classical reconstruction, transfer learning, and zero-shot reconstruction.

eess.IV↗
arXiv2026

Lightweight Interpretable RGB-Guided Hyperspectral Super-Resolution under Real Cross-resolution Misalignment

Compact snapshot hyperspectral cameras provide rich instantaneous spectral measurements for ground-level machine vision, but at lower spatial resolution than standard RGB cameras. RGB-guided hyperspectral super-resolution (HSR) addresses this limitation by transferring spatial detail from a high-resolution RGB guide to a low-resolution hyperspectral image (HSI). These dual-camera systems are typically in a horizontal rig geometry, requiring cross-camera image alignment due to different fields of view. However, residual misregistration can inject spurious high-frequency details. Existing learned unaligned-fusion methods are usually trained for a fixed spectral support and spatial scale factors and can be computationally demanding, limiting their flexibility across sensors. We propose a lightweight and interpretable RGB-guided HSR framework combining cross-modal flow alignment with model-based Gram-Schmidt orthogonalization fusion. The method first warps the RGB guide onto the HSI grid, then estimates an energy-based confidence weight map by measuring local alignment reliability. This map is then used both in a weighted least-squares spectral regression and in a gated fusion between the super-resolved estimate and an HSI-preserving estimate. Unlike existing learned methods, the proposed framework has a low computational footprint and supports VIS-NIR spectral supports and scale factors without retraining. Experiments on the Real benchmark show that the proposed method improves reconstruction accuracy over learned fusion baselines while remaining substantially faster. On a 34-frame sequence acquired with our real RGB-HSI dual-camera setup, a reduced-resolution quantitative evaluation validates the method under genuine cross-sensor radiometric, noise, and geometric differences, while native-resolution qualitative results demonstrate deployment on the full 51-band VIS-NIR acquisition.

eess.IV↗
arXiv2026

Cross-dataset transportability of pediatric chest X-ray deep learning across three countries: discrimination, calibration, operating-point failure, and limited-label recovery

Background and Objective: External evaluation of medical-imaging AI is often collapsed into discrimination. We evaluated a computational protocol that separately tests discrimination, probability calibration, fixed operatingpoint transport, shortcut-associated signal, and limited-label recoverability for pediatric pneumonia classification across datasets from three countries. Methods: After exact-duplicate removal, 5,824 Guangzhou radiographs supported leakage-controlled source development and internal testing. A frozen three-seed DenseNet121 dual-view ensemble was evaluated zero-shot on BDCXR-3257 from Bangladesh (n = 3, 257) and an untouched harmonized VinDr-PCXR/PediCXR test cohort from Vietnam (n = 1, 077). Matched seed-42 variants tested architectural robustness. Secondary BDCXR analyses used a fixed 651-image adaptation pool and 2,606-image hold-out; 163, 326, and 651 labels represented 5%, 10%, and 20% of complete BDCXR. Results: Internal AUROC was 0.976 with 95.1% sensitivity. BDCXR and VinDr-PCXR AUROC were 0.798 and 0.742, while frozen-threshold sensitivity fell to 6.2% and 0%. Source-to-BDCXR AUROC degradation occurred for a full-image baseline (0.961 to 0.749), ungated dual-view model (0.977 to 0.766), and gated MixStyle model (0.966 to 0.789). With 163 BDCXR labels, Platt recalibration preserved AUROC while increasing held-out sensitivity to 88.3%, but specificity was 47.9% and the alert rate was 78.5%. Two hundred repeated 163-label fits confirmed sensitivity recovery but substantial specificity variability. Conclusions: Cross-dataset shifts across countries affected ranking, probability alignment, and source-defined decision behavior differently. Transport studies should evaluate these components separately and quantify the operational burden of apparent recovery.

eess.IV↗
arXiv2026

Medical Foundation Model Features as Perceptual Loss for Brain MRI Contrast Dose Simulation

Perceptual losses are widely used in medical image synthesis because they encourage agreement in high-level structure beyond voxel-wise intensity similarity. In practice, most perceptual losses are still computed with natural-image backbones such as VGG16 or ResNet50, even when the target domain is magnetic resonance imaging (MRI). This mismatch may weaken supervision for anatomy, contrast enhancement, and acquisition variability. We test whether medical foundation model features provide a more suitable perceptual loss for brain MRI contrast dose simulation. The study has two stages. First, we compare RadImageNet, SegVol, and BrainIAC with ImageNet-pretrained VGG16 and ResNet50 as frozen feature extractors on four public medical imaging benchmarks: thyroid ultrasound, breast ultrasound, anterior cruciate ligament knee MRI, and meniscus knee MRI. RadImageNet achieves the lowest mean rank across the Stage I representation suite and is selected as $ϕ^\star$. Second, we replace only the VGG16 feature extractor in an existing iterative brain MRI dose simulation framework with $ϕ^\star$. The generator, reconstruction loss, adversarial loss, auxiliary losses, optimization schedule, and loss weights are kept unchanged. Standard metrics change modestly, with PSNR increasing from 41.63 to 41.74, SSIM from 0.9739 to 0.9754, RMSE decreasing from 0.1384 to 0.1369, and residual-uptake CNR from 0.0085 to 0.0082. The visual results show the main effect: RadImageNet reduces residual enhancement in marked structures, follows a more faithful dose-reduction trajectory, and remains close to the acquired 10% low-dose target. These results support domain-aligned radiology features as a practical perceptual feature space for MRI dose simulation, while leaving clinical equivalence and larger-cohort validation as future work.

eess.IV↗
arXiv2026

Cross-modal triage network: a multimodal deep learning framework for severity-based triage and visual explainability in chest radiographs

Purpose: Increased number of chest radiograph (CXR) scans create a triage bottleneck, queueing urgent examinations behind routine ones. Existing AI tools are predominantly unimodal binary classifiers lacking severity awareness, and multimodal systems are rarely benchmarked against expert radiologists. To this end, we developed a multimodal deep learning framework for joint severity triage, pathology detection, and native visual explanation. Approach: We propose the cross-modal triage network (CMTN), fusing a Swin Transformer V2 visual encoder with a PubMedBERT text encoder via gated cross-attention. The CMTN was trained on 34,639 image-text pairs (12,489 patients) from MIMIC-CXR-JPG, optimizing an ordinal focal loss for four-tier severity triage and binary cross-entropy for 14 pathologies. Beyond quantitative benchmarking, attention heatmaps were evaluated against a blinded expert radiologist in a two-phase clinical audit comparing model triage output to expert severity assessment (100 cases) and grading spatial-semantic concordance (116 heatmaps). Results: The CMTN achieved strong ordinal agreement with reference labels (quadratic weighted kappa [QWK] = 0.9341, 95\% CI: 0.9219 to 0.9449) and macro-AUROC of 0.9970 across 14 pathologies, with 34~ms latency, outperforming the state-of-the-art BioViL multimodal baseline (QWK = 0.7679). However, the blinded Phase I clinical audit revealed substantially lower agreement with genuine radiologist judgment (QWK = 0.1399). Phase II found 54.3\% of heatmaps achieved clinically acceptable spatial localization. Conclusions: The CMTN demonstrated an efficient multimodal architecture for CXR triage. The divergence between algorithmic and radiologist agreement demonstrates that benchmark performance against NLP-derived labels is insufficient, highlighting the need for radiologist-labeled ground truth before clinical deployment.

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arXiv2026

A Computational Pipeline for Patient-Specific Modeling of Thoracic Aortic Aneurysm: From Medical Image to Finite Element Analysis

The aorta is the body's largest arterial vessel, serving as the primary pathway for oxygenated blood within the systemic circulation. Aortic aneurysms consistently rank among the top twenty causes of mortality in the United States. Thoracic aortic aneurysm (TAA) arises from abnormal dilation of the thoracic aorta and remains a clinically significant disease, ranking as one of the leading causes of death in adults. A thoracic aortic aneurysm ruptures when the integrity of all aortic wall layers is compromised due to elevated blood pressure. Currently, three-dimensional computed tomography (3D CT) is considered the gold standard for diagnosing TAA. The geometric characteristics of the aorta, which can be quantified from medical imaging, and stresses on the aortic wall, which can be obtained by finite element analysis (FEA), are critical in evaluating the risk of rupture and dissection. Deep learning based image segmentation has emerged as a reliable method for extracting anatomical regions of interest from medical images. Voxel based segmentation masks of anatomical structures are typically converted into structured mesh representation to enable accurate simulation. Hexahedral meshes are commonly used in finite element simulations of the aorta due to their computational efficiency and superior simulation accuracy. Due to anatomical variability, patient specific modeling enables detailed assessment of individual anatomical and biomechanics behaviors, supporting precise simulations, accurate diagnoses, and personalized treatment strategies. Finite element (FE) simulations provide valuable insights into the biomechanical behaviors of tissues and organs in clinical studies. Developing accurate FE models represents a crucial initial step in establishing a patient-specific, biomechanically based framework for predicting the risk of TAA.

eess.IV↗
arXiv2026

Explainable Convolutional Neural Networks for Retinal Fundus Classification and Cutting-Edge Segmentation Models for Retinal Blood Vessels from Fundus Images

Early detection of vision-threatening conditions such as diabetic retinopathy, glaucoma, and age-related macular degeneration depends on retinal fundus image analysis, but manual assessment is slow and expert-dependent. Automated convolutional neural networks classify fundus images accurately yet act as black boxes, and existing retinal vessel segmentation methods lose discriminative power under pathology and seldom exploit attention or transformer backbones. Using the FIVES and DRIVE fundus datasets, we develop a two-pipeline framework that pairs four-class disease classification with attention- and transformer-based vessel segmentation, organised in three stages: (1) FIVES images are augmented by rotation and horizontal and vertical flips and used to fine-tune eight ImageNet-pretrained CNNs: ResNet101, DenseNet169, Xception, InceptionV3, DenseNet121, InceptionResNetV2, ResNet50, and EfficientNetB0. (2) Five gradient-based explanation methods, Grad-CAM, Grad-CAM++, Score-CAM, Faster Score-CAM, and Layer-CAM, are computed on the final convolutional block of each classifier and compared qualitatively across architectures. (3) Ten U-Net variants are benchmarked for vessel segmentation: TransUNet (hybrid CNN--Transformer encoder) and Attention U-Net (gated skip connections), evaluated with ResNet50V2, ResNet101V2, and ResNet152V2 backbones, along with additional Attention U-Net configurations using DenseNet backbones, and the fully transformer-based Swin-UNet. ResNet101 gives the highest classification accuracy: 94.17% (F1 0.942) $>$ 88.33% for EfficientNetB0. For segmentation, the architecture ranking is consistent on both datasets: Attention U-Net $>$ TransUNet $>$ Swin-UNet. The strongest configuration is Attention U-Net with a ResNet101V2 backbone: FIVES IoU 0.722, Dice 0.838; DRIVE IoU 0.648, Dice 0.787, lifting DRIVE IoU 60.80 $\rightarrow$ 64.83 over a prior custom U-Net.

eess.IV↗
arXiv2026

Enhancing brain age estimation with structural MRI and synthesized cerebral blood volume maps

BrainAGE is a promising imaging-derived biomarker of neurobiological ageing and disease risk, yet current approaches rely predominantly on T1-weighted structural MRI, overlooking functional vascular changes that may precede tissue damage and cognitive decline. DeepCBV maps, synthesized from non-contrast MRI, offer a scalable alternative to contrast-enhanced perfusion imaging by capturing vascular information relevant to early neurodegeneration. We developed a multimodal BrainAGE framework that combines predictions from two separate three-dimensional convolutional neural networks: one trained only on structural MRI scans and another trained only on DeepCBV maps. Each model was trained and validated on 2851 scans from 13 open-source datasets and was evaluated for concordance with MCI and AD. The combined model achieved the most accurate brain age gap for CN controls, with a mean absolute error of 3.95 years, outperforming models trained on MRI or DeepCBV alone. Saliency maps revealed complementary modality contributions: MRI emphasized white matter and cortical atrophy, while DeepCBV highlighted vascular-rich and periventricular regions implicated in hypoperfusion and early cerebrovascular dysfunction, consistent with known patterns of normal ageing. Next, we observed that BrainAGE increased stepwise across diagnostic strata (CN < MCI < AD) and correlated with cognitive impairment. DeepCBV-based BrainAGE showed a particularly strong separation between stable versus progressive MCI, suggesting sensitivity to prodromal vascular changes that precede overt atrophy. Integrating structural MRI with deep learning-derived vascular measures substantially enhances BrainAGE estimation and improves sensitivity to MCI and AD progression, supporting its potential role in risk stratification, early detection and monitoring of therapeutic response.

eess.IV↗
arXiv2026

Coronary Mask Guided Registration for Continuous Time 4D Cardiac CT Dataset Construction

Objective: Clinical cardiac CT multiphase reconstructions generally provide acceptable image quality in end-diastole (ED) or end-systole (ES) phases, but in other phases may exhibit motion artifacts, especially in the right coronary artery (RCA). This limits ground-truth availability in 4D cardiac CT imaging research. We aim to construct a 4D cardiac CT dataset that is generally suitable to serve as pseudo ground truth. Methods: We propose Coronary Mask Guided Registration (CMGR) to produce a motion-preserved, artifact-reduced, and continuous-time 4D cardiac CT sequence from the clinical multiphase reconstruction of each patient. For artifact reduction, CMGR uses the ED or ES phase as the reference phase and warps the reference volume with deformation fields to produce the sequence. For motion preservation, CMGR registers the reference phase to each non-reference phase of the multiphase reconstruction. To capture the motion of both the RCA and other cardiac structures in each registration, CMGR regularizes RCA masks and incorporates them into image-domain registration. Time-continuity is achieved by interpolating the deformation fields for non-reference phases to arbitrary times. Results: CMGR outperformed representative image-domain registration methods in capturing RCA motion and providing reasonable RCA shape, and showed competitive performance in capturing whole-heart motion. Additionally, CMGR reduced motion artifacts from clinical multiphase reconstructions, and intermediate CMGR frames generally provided plausible transitions between discrete cardiac phases. Conclusion: CMGR provides an effective approach for constructing continuous-time 4D cardiac CT datasets. Significance: The dataset can be used in system design simulations and in reconstruction algorithm development, thereby facilitating advances in cardiac CT imaging.

eess.IV↗
arXiv2026

AI-based single-shot structured-light depth reconstruction for real-time laparoscopic surgical guidance

Significance. Accurate intraoperative depth perception is important for autonomous and semi-autonomous robotic laparoscopic surgery. Conventional fringe projection profilometry can achieve millimeter-scale accuracy but often requires multi-shot acquisition, digital-micromirror-device projection, and projector-camera synchronization, complicating integration into compact laparoscopic systems. Aim. To develop a synchronization-free, single-shot depth-sensing platform using a passive LED-illuminated binary mask and a VQ-VAE prior with a custom U-Net depth head. Approach. A compact projection module was coupled to one channel of a dual-channel laparoscope, while the second channel imaged the fringe-illuminated target. A Zivid 3D camera acquired reference depth for 722 paired phantom images. Zivid depth maps were reprojected into the SSLE image frame for supervised training and evaluation. The VQ-VAE encoded each input into a discrete latent representation, and a latent-space U-Net predicted depth without a separate mask-prediction branch. Results. Using a fixed train/validation/test split, the proposed model achieved an MAE of 3.70 mm, AbsRel of 0.0326, delta=1.1 accuracy of 0.962, and delta=1.1^2 accuracy of 0.970. It achieved lower MAE than the dual U-Net MaskNet + DepthNet baseline and outperformed off-the-shelf monocular depth models in MAE, AbsRel, and threshold accuracy. The pipeline operated at 26.0 Hz over 301 consecutive frames on an NVIDIA A100 GPU. Conclusions. The LED-illuminated binary-pattern platform with latent-space depth reconstruction enables synchronization-free, video-rate endoscopic depth estimation. Results demonstrate Zivid-referenced phantom reconstruction without an explicit segmentation stage, while emphasizing the importance of dataset size and SSLE-Zivid calibration accuracy.

eess.IV↗
arXiv2026

AtlasPatch: Scalable Foundation Model-based Tissue Detection and Patch Extraction for Computational Pathology

Whole-slide image (WSI) preprocessing, including tissue detection and patch extraction, is critical computational pathology, yet remains a major bottleneck for large-scale workflows. Existing methods often rely either on threshold-based heuristics that are sensitive to staining variations, tissue fragmentation, and artifacts, or on patch-wise deep learning pipelines with substantially higher computational cost. We present AtlasPatch, a scalable high-throughput WSI preprocessing method built around a foundation-model-based tissue detector that operates at thumbnail resolution: a single thumbnail-level forward pass yields a tissue mask that directly guides patch coordinate generation at the target desired magnification, avoiding repeated patch-level inference. The proposed detector's robustness and efficiency is driven by two coupled contributions: (i) a parameter-efficient adaptation of the SAM2 foundation model that updates only its layer-normalization parameters (0.076% of model weights), and (ii) a curated and semi-manually annotated multi-cohort dataset of 30,000 WSI thumbnail-mask pairs deliberately spanning multiple organs, scanners, tissue appearances, and artifacts. The detector is coupled with pyramid-aware contour mapping from thumbnail to full-resolution slide coordinates, enabling direct patch coordinate generation at the target magnification and parallelized high-throughput patch extraction. AtlasPatch's tissue detection achieves a precision of 0.986 and remains robust across slide variations. Compared with widely used deep-learning preprocessing methods, AtlasPatch is up to 16x faster while preserving downstream multiple-instance learning performance across six slide-level classification tasks. These results position AtlasPatch as a frontier of efficient preprocessing in large-scale computational pathology and pathology foundation models.

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arXiv2026

Cross-Dataset Transfer and Reliability of Explainable Artificial Intelligence for RhythmFormer Remote Photoplethysmography

Background. Remote photoplethysmography estimates the cardiovascular pulse from facial video, and its explanations have rested on inspecting heatmaps rather than on quantitative evidence about where a model reads it. We quantified the explanations and asked whether such explanations transfer between datasets and track model performance. Method. We trained eight condition-specific RhythmFormer models on NCKU-rPPG, recorded under three illumination levels, speaking, rotation, and cycling, estimated one heart rate per 5.12-second clip, and set them beside a UBFC-rPPG reproduction. Raw attention, rollout, attention flow, and Beyond Intuition were assessed by skin coverage and the Salience-guided Faithfulness Coefficient (SaCo). Results. Beyond Intuition ranked highest on both datasets, at median coverage 0.789 and SaCo 0.837 on Static level 3 against 0.826 and 0.917 on UBFC-rPPG; lower ranks differed. Within one participant of one condition, neither measure was related to a clip's heart-rate error, waveform correlation, or signal-to-noise ratio on either dataset: 186 of the 252 coefficients fell below $|ρ|=0.10$ and 28 reached $p<0.05$ against the 13 expected by chance. Across the eight scenarios only Beyond Intuition's coverage followed the three performance measures, at $ρ=-0.43$, $+0.57$, and $+0.43$, while the attention-only methods' SaCo ran opposite to each. It failed at 40 lux alone, its median coverage falling to 0.180 and its median SaCo to $-0.178$, whereas motion degraded the estimates far more without such a drop. Conclusions. Skin coverage and SaCo carry information complementary to the performance measures rather than a proxy for them: attributing to the skin does not guarantee an accurate estimate. What an attribution reveals about a condition is where the model looks rather than how faithfully its map is ordered.

cs.CV↗
arXiv2026

The MYOSAIQ Challenge: Myocardial Segmentation with Automated Infarct Quantification

Late gadolinium enhancement (LGE) cardiac magnetic resonance (MR) imaging is the modality of choice to assess myocardial infarction (MI) lesions. Nowadays MI volume quantification is not performed routinely in clinical practice. Numerous deep learning (DL) methods have been developed to automate the segmentation of the myocardium and infarct regions. However, most studies rely on relatively small datasets which typically undergo pre-processing steps to standardize images and focus on a specific phase of myocardial infarction following reperfusion therapy. These limitations have impeded the development of models that are generalizable across diverse conditions and thus suitable for routine clinical use. To advance research and establish benchmarks in generalizable learning for myocardial infarct quantification, this paper presents findings from the Myocardial Segmentation with Automated Infarct Quantification (MYOSAIQ) challenge. The dataset set up for the challenge combines 439 CMR volumes from two multicenter clinical trials, with representative data acquired in acute and chronic phases after acute MI. Data were acquired in 16 centers using MRI scanners from three different vendors. Six teams participated until the end of the challenge, employing various baseline models, data augmentation techniques, and confidence strategies. To enhance the significance of this study, we compare the challengers' results with those of fine-tuned foundation models. Our results indicate that well-designed UNet-based techniques outperform fully automatic foundation models for LGE MR segmentation. While the best methods achieve high-quality and stable delineations of the left ventricle and myocardium under various conditions, they remain improvable in accurately segmenting infarct regions.

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arXiv2026

Ask Twice, Look Twice: Prompt Echoing Resolves the Question-First Paradox in Vision-Language Models

Where should the question go in a vision-language model (VLM) prompt: before the image or after it? Intuition says before: knowing what is asked should tell the model where to look. Yet across visual question answering benchmarks, question-first prompting consistently underperforms the image-first ordering recommended for frontier VLMs, a phenomenon we term the question-first paradox. We trace this paradox to a conflict between two stages of VLM computation. Logit-lens and attention probes show that question-first prompting steers perception, shifting image patch representations toward question-relevant concepts. But downstream, stranded behind hundreds of image tokens, the question is barely attended by the answer token, which instead commits to image-driven, often wrong answers. Causal attention knockout confirms that the answer reads the question only when it follows the image. This diagnosis yields a training-free fix: question echoing, restating the question on both sides of the image so one copy steers perception while the other is available at answer time. A similar division of labor appears in a fifty-year-old finding on human 'adjunct questions', where repeating a question before and after a passage improves comprehension. Echoing the image as well brings further gains by restoring the whole-image view otherwise lost by a causal decoder. The paradox holds across five open VLMs, costing up to 17.5 group-accuracy points. Echoed prompts recover most of the gap and, on NaturalBench and Winoground, surpass the best single-pass ordering by up to 19 group-accuracy points on Winoground, with no training, fine-tuning, or architecture change. The paradox reveals a tension between steering what a model sees and preserving access to what it was asked; echoing resolves this through prompt design. Project Page: https://rakshanda-cmu.github.io/ask-twice-look-twice/

cs.CV↗
arXiv2026

Beat-Synchronous Tokenization for ECG Transformers

Transformer-based electrocardiogram (ECG) models commonly tokenize waveforms into fixed temporal patches. Though convenient, fixed patching can split heartbeat structures across token boundaries. We study beat-synchronous tokenization as a physiologically grounded alternative, comparing fixed patches with three beat-aligned strategies: resampled beats, adaptive pooled beats, and resampled beats augmented with R--R interval information. Experiments span two settings: 10-second 12-lead diagnostic classification on PTB-XL after MIMIC-IV-ECG masked pretraining, and 60-second single-lead rhythm classification on Icentia11k after patient-level contrastive pretraining. On PTB-XL, resampled beat tokens achieve the highest mean macro Area Under the ROC Curve (AUROC; 0.8945) and nearly match the best fixed-patch macro Area Under the Precision-Recall Curve (AUPRC; 0.7414), reducing average sequence length from 100 to 11.2 tokens. On Icentia11k, beat-synchronous tokenizers obtain comparable AUPRC to fixed patching with better stability across runs. These results suggest morphology-preserving beat tokenization is a compact, competitive alternative to fixed temporal patching.

cs.LG↗
arXiv2026

Scalable Voltage-Stability Dataset Generation Via Boundary-Proximity Indicators Clustering

This paper proposes a scalable framework for voltage-stability dataset generation. Voltage-stability-constrained planning increasingly relies on machine-learning surrogates but training them requires large datasets labelled by continuation power flow (CPF) results, which is computationally costly. To address this, this paper proposes a framework that uses hierarchical clustering on boundary-proximity indicators to reduce the number of required CPF evaluations. The proposed approach combines (i) uniform sampling of feasible operating space using Hit-and-Run Markov Chain Monte Carlo, (ii) structured stress directions via maximin Latin hypercube sampling (LHS), (iii) sensitivity-guided perturbations to target weak buses, and (iv) clustering-based representative CPF labelling that reconstructs the voltage stability margins of unlabelled operating points from representative cluster medoids. Results on the IEEE 39-bus system show that the proposed framework significantly reduces CPF evaluations by 95.45% while preserving high accuracy and boundary fidelity for both regression and classification tasks. The reduced surrogates remain structurally consistent with their full-CPF dataset counterparts, demonstrating the suitability and scalability of the proposed approach for operation and planning optimization.

eess.SY↗
arXiv2026

Auditing Bias and Safety in Voice AI Customer Care

Voice AI systems increasingly mediate customer care interactions where caller presentation cues such as accent, affect, fluency, and urgency are available alongside the service request. Existing fairness and safety evaluations cover speech recognition disparities, spoken dialogue bias, and voice agent capability, but rarely treat customer care voice agents as stateful, multi turn, tool mediated systems where harm can appear as additional burden before any final denial occurs. We formalize a validation gated audit framework for such systems. The framework (i) separates native speech to speech, cascaded ASR to language model to TTS, and hybrid tool mediated architectures; (ii) uses matched service facts across controlled caller presentation conditions; (iii) validates fact invariance, presentation cues, artifacts, and acoustic measurements before inference; and (iv) records both material outcomes and path to service burden. We define the research problem, methodology, seven validation gates, a six family metric set, and claim boundaries for an active industry evaluation program. We illustrate the framework with a fully synthetic worked example of a refund dispute audit instance. Production system results are excluded from this release; public reporting is gated by the validation protocol.

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