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arXiv

Object Counting Across Modalities: Taxonomies, Benchmarks, Applications, and Open Challenges

Joana Konadu Owusu, Shivanand Venkanna Sheshappanavar

Object-counting methods have rapidly shifted from class-specific density regression to open-vocabulary, foundation-model-backed counters. These methods now enumerate instances from various visual and textual prompts. While this shift marks major conceptual progress, our survey argues that claims of universal generality have outpaced the evaluative infrastructure. Most progress metrics rely on a few saturated benchmarks that models exploit for statistical regularities. Newly introduced diagnostic datasets reveal systematic failures in semantic grounding, temporal identity, and spatial reasoning with occlusion. To address these failures, we introduce a five-axis taxonomy (modality, mechanism, prompting, supervision level, and generalization setting). We use this taxonomy to audit the literature across application domains, including microscopy, remote sensing, crowd counting, and agriculture. This formalizes prevailing challenges into six structural contradictions. From these, we propose a roadmap for compositional scene understanding, active counting agents, and unified multimodal evaluation protocols. The main imperative is to build a robust evaluation infrastructure to distinguish open-world generalization from benchmark-specific optimization, rather than simple incremental engineering.

arXiv

Infant Care Video Dataset for Classification of Interventions Using Transformers

Igor Bogdanov, James Green

Healthcare documentation in the neonatal intensive care unit (NICU) presents significant challenges, with nurses spending approximately 25\% of their time on record-keeping, while up to 60\% of interventions remain undocumented. Motivated by the need to detect interventions from video automatically, we present the Infant Care Video Dataset (ICVD), a collection of 4,144 videos spanning 12 simulated intervention classes designed for developing automated documentation systems. Our manikin-based approach systematically varies conditions, such as camera angle and clinician skin tone, while ensuring privacy compliance. Using video transformer architectures (TimeSformer and MotionFormer), we establish strong baseline performance (93.97\% and 93.17\% top-1 accuracy) among the 12 infant care classes. Our ablation study comparing temporal models with a framewise approach (23.17\% accuracy) demonstrates a 70.80\% performance gap, validating the need for temporal modeling. The ICVD provides a foundation for developing automated documentation systems to reduce clinical burden in neonatal care environments and improve existing practices.

arXiv

Predicting Radiologist Expertise from 3D Gaze Patterns During CT Interpretation

Leila Khaertdinova, Anna Anikina, Claudia Mello-Thoms, Bulat Ibragimov

Accurate interpretation of volumetric CT requires efficient navigation of 3D image volumes and attention to diagnostically relevant regions. While eye-tracking has been widely studied in 2D medical imaging, its use for expertise assessment in CT settings remains limited. We propose a gaze-informed transformer framework for expertise classification in thoracic CT. Using a DINOv2 backbone, radiologist fixation patterns are integrated into volumetric feature learning through (1) a learnable log-space bias in self-attention and (2) gaze-weighted pooling of patch embeddings. We trained and evaluated our approach on 182 CT reading sessions from five radiologists with varying levels of experience. On a held-out test set, the model achieves an ROC-AUC of 0.91 and F1 score of 0.86, outperforming adapted methods. These findings suggest that incorporating visual search behavior into transformers may support objective, process-based expertise assessment in radiology. Code is available via https://github.com/leiluk1/GazeToSkill.

arXiv

Restoring Without Forgetting: Continual Learning Across Image Degradations

Alif Ashrafee, Bartosz Krawczyk

Recent progress in image restoration has converged on all-in-one architectures that jointly handle multiple degradations within a single network. These methods are effective on static benchmarks but target a closed-world setting that assumes simultaneous access to every target degradation at training time. In practice, degradations are encountered sequentially as field-deployed systems progressively face new environmental conditions, and historical training data is often unavailable due to privacy or storage constraints. Accommodating a new degradation then requires either retraining on the union of all prior data, which is often costly or infeasible, or fine-tuning, which causes catastrophic forgetting. We formulate multi-degradation image restoration as a continual domain-incremental learning problem, in which degradations arrive incrementally and prior data is unavailable. Our proposed Restoring without Forgetting (RwF) framework learns a lightweight adapter for each new degradation, eliminating forgetting by construction at a fraction of the cost of dedicated per-domain networks. To isolate degradation learning from dataset variation, we construct a benchmark spanning five degradation domains under shared image content. At test time, an unsupervised routing mechanism identifies the appropriate restoration path for unknown inputs without requiring domain labels. Across the five-domain sequence, RwF improves final average PSNR over naive sequential fine-tuning by 15.25 dB and 11.83 dB on the Restormer and NAFNet backbones, respectively. The framework transfers to eleven canonical real-degradation benchmarks (3,465 images) at 89.5% routing accuracy with only a +0.94 dB oracle PSNR gap, establishing, to our knowledge, the first systematic baseline for continual multi-degradation image restoration.

arXiv

Mixture of Channel Experts: Static Sparse Supports with Input-Adaptive Mixing for Pointwise Projections

Elian Iluk, Gil Ben-Artzi

Mixture-of-Experts (MoE) scales language models by routing each input through a small set of independently parameterized experts. We show that copying this design into convolutional networks fails for a structural reason: parallel convolutional experts that read the same input channels learn nearly identical filters. We therefore move the expert axis from operator duplication to channel selection. We introduce Mixture of Channel Experts (MoCE), a structured sparse channel-mixing layer, inspired by MoE, that replaces pointwise (1x1) channel-reduction projections. In MoCE, an expert is a single output channel with a learned sparse support of k << C input channels. The selected channels are combined by a softmax whose temperature is predicted per input, so each expert can move between mean-like and max-like aggregation. A residual expert summarizes the unselected channels, and a load-balancing loss keeps channel coverage complete. MoCE replaces a dense projection whose cost is quadratic in C with a mechanism whose relative cost scales as k/C, and the predicted savings hold in measured wall-clock time. Across ResNet backbones on ImageNet-1K and CIFAR-100, transfer learning, EfficientViT, and a strong modern training recipe, MoCE matches or exceeds dense baselines and prior channel-selection methods while reducing MACs by 16.7% and end-to-end latency.

arXiv

Primate vision reveals a missing principle for robust dynamic AI

Matteo Dunnhofer, Christian Micheloni, Kohitij Kar

How does an intelligent visual system combine what objects look like with how they move while remaining robust as appearance changes? We addressed this question by comparing human perception and neural activity in macaque inferior temporal cortex with representations from image- and video-based neural networks spanning recognition, segmentation, optic-flow processing and predictive world modeling. Temporal integration improved object representations, but most video recognition models generalized poorly when appearance was disrupted while motion structure was preserved. Humans and macaque IT remained robust. Notably, predictive world models combined strong cross-appearance generalization with the closest correspondence to IT, outperforming other video-modeling approaches in neural fidelity. Yet no model reproduced the cortical transformation from early appearance-dominated responses toward later appearance-invariant motion coding. These results identify progressive integration of motion into object representations as a principle of robust dynamic vision and implicate predictive learning as a promising route toward realizing this computation in artificial systems.

arXiv

Too much of a good thing -- when knowledge distillation promotes overfitting, and how to avoid it

Irene Trigueros-Lorca, Leonardo Concepción, Christian Wagner, Isaac Triguero, Daniel Molina

The growing size of Convolutional Neural Networks has led to increasingly large and costly models. Knowledge Distillation (KD) addresses this by transferring knowledge from a large network (teacher) to a small one (student), also reducing the training data required. KD is traditionally applied only at the network's final output. However, its behaviour when applied at intermediate network layers has received little attention. This raises the question of whether intermediate block-wise KD, which provides supervision throughout the network, could offer an advantage under specific conditions, such as few instances per class, which is common in fine-grained datasets. This work proposes a student design based on simple, homogeneous blocks mirroring those of the teacher, distilling knowledge between corresponding blocks. Across eleven datasets, we show that on classic datasets, distilling only the last block is sufficient -- and often best--, whereas fine-grained, data-scarce settings benefit substantially from intermediate supervision, with even a single additional distillation point narrowing the gap considerably. We further study how this supervision should be guided, exploring configurations of varying granularity and informed by an explainability analysis based on attention maps, Centered Kernel Alignment, and Grad-CAM, alongside the impact of teacher and student fine-tuning strategies. This work shows that intermediate block-wise distillation, guided appropriately, is key to building compact data-efficient models without sacrificing accuracy.

arXiv

CRISP: Calibration-Aware Visual State Space Duality for Remote Sensing Semantic Segmentation

Kangning Wang, Haopeng Zhang, Zhiguo Jiang

State space models, especially Visual State Space Duality (VSSD), have emerged as efficient linear-time alternatives to Transformers for dense visual tasks. However, we observe that VSSD compresses spatial context into a global aggregation that suppresses high-frequency responses, causing excessive boundary smoothing in remote sensing semantic segmentation. To address this, we propose CRISP, a calibration framework with two components. Its core, the Duality Calibration Operator (DCO), restores local contrast and boundary responses through residual injection and frequency calibration within the VSSD backbone, without altering its linear complexity. To retain the recovered detail, an Orthogonal Multi-Prototype (OMP) head assigns multiple orthogonally constrained prototypes per class to model large intra-class variance. Extensive experiments on Potsdam, Vaihingen, and LoveDA show that, with approximately 30M parameters, CRISP achieves consistent gains in mean F1 (mF) and mIoU while remaining competitive with state-of-the-art methods. Code is available at https://github.com/crazylifeha/CRISP.

arXiv

Multi-Stage Prompt-Guided Feature Modulation for Generalizable Brain Tumor Segmentation

Mohammad Mahdi Danesh Pajouh, Sara Saeedi

Accurate brain tumor segmentation from magnetic resonance imaging (MRI) is essential for diagnosis, treatment planning, surgical guidance, and disease monitoring. However, developing automated segmentation models that generalize across diverse tumor characteristics, imaging protocols, acquisition sites, and patient populations remains challenging. Variations in tumor morphology and imaging distributions can substantially degrade performance outside the training domain. Consequently, improving the robustness and generalization of deep learning-based segmentation models has become a key objective in medical image analysis. To improve segmentation robustness, we propose Multi-Stage Dynamic Prompt nnU-Net, a prompt-conditioned extension of nnU-Net. Three independent dynamic prompt modules are inserted into the deepest encoder stages. Each module contains a learnable bank of ten 256-dimensional prompt vectors and uses globally pooled encoder features to generate image-specific prompt representations. These representations are projected into feature-wise scaling $(γ)$ and shifting $(β)$ parameters that modulate encoder feature maps through Feature-wise Linear Modulation (FiLM), enabling adaptive feature conditioning at multiple semantic levels. Evaluation on the BraTS GOAT validation dataset demonstrated that the proposed Multi-Stage Dynamic Prompt nnU-Net outperformed the baseline nnU Net across the majority of evaluated metrics and tumor subregions. The proposed model achieved average lesion-wise Dice scores of 76.16% (ET), 80.04% (TC), and 86.42% (WT), compared with 74.38%, 78.14% and 84.01% for the baseline model. The results demonstrate that multi-stage dynamic prompt conditioning improves segmentation accuracy and boundary delineation for brain tumor segmentation.

arXiv

Velocity-coupled Representation Refinement for Satellite Orbit Prediction

Yue Yang, Zhiqiang Wu, Saiyu Qi, Fan Ma

Satellite orbit prediction, which aims to forecast future orbital trajectories from historical observations, is important for collision warning and safe space operations. With advances in time-series forecasting, learning-based methods have emerged as a promising solution for satellite prediction. In orbital dynamics, a satellite state is typically described by position and velocity, where position characterizes trajectory geometry and velocity reflects its instantaneous direction and rate of change. However, most existing methods mainly focus on temporal dependencies within position sequences while rarely exploiting the intrinsic coupling between position and velocity, which is essential for modeling satellite motion. To this end, we propose OrbitNet, a velocity-aware representation learning method for accurate satellite orbit prediction. It lifts conventional position-sequence forecasting to a position-velocity coupled representation learning paradigm by exploiting relationships among satellite state variables. Specifically, we develop a velocity-coupled representation refinement strategy to enhance positional representations through cross-variable interactions between position and velocity. We further introduce orbital segment modeling, which partitions historical trajectories into temporal segments and performs segment-level temporal learning to capture local motion variations and long-range evolution patterns. Extensive experiments show that OrbitNet outperforms large time-series foundation models and representative general forecasting methods under both in-domain evaluation on Starlink and zero-shot evaluation across six unseen satellite constellations. We expect this work to encourage further exploration of satellite-aware representation learning for trajectory time-series forecasting.

arXiv

DriftAD: Visually-Guided Text Drift for Few-Shot Industrial Anomaly Detection

Wenyang Liu, Tianyi Liu, Dongshuo Zhang, Kejun Wu, Adams Wai-Kin Kong

Few-shot anomaly detection (FSAD) has recently benefited from vision-language models such as CLIP, which enable anomaly de?tection by aligning visual features with text descriptions of normal and abnormal states. However, existing methods typically rely on static text prompts that are applied uniformly across the entire feature hierarchy and spatial dimensions. This rigid global-to-local matching fails to capture the highly localized and scale-dependent physical variations of industrial defects. To address this, we propose DriftAD, a FSAD framework built on three key modules. First, an Anomaly Signal Amplification (ASA) module enhances subtle defect signals through spatial and frequency branches before text-visual matching. Second, Visually-Guided Text Drift (VGTD) dynamically transforms frozen CLIP text embeddings, steering them into layer?wise, spatially-adaptive anomaly descriptors conditioned on local visual context at each encoder depth. Third, Drift-Guided Spatial Gating (DGSG) uses the drifted abnormal descriptor as a spatial probe to selectively enhance anomaly-relevant visual features. Addi?tionally, a drift separation loss prevents representational collapse of the drifted descriptors, and a gate supervision loss enforces spatially discriminative gating in DGSG. Extensive experiments on MVTec?AD and VisA demonstrate state-of-the-art performance across all 1-, 2-, and 4-shot settings on both image-level and pixel-level metrics. Code is available at https://github.com/wenyang001/DriftAD.

arXiv

Scaling Reinforcement Learning for Diffusion Models via Velocity Matching

Jaemoo Choi, Wei Guo, Yuchen Zhu, Arash Vahdat, Molei Tao, Julius Berner, Yongxin Chen

Reward fine-tuning is becoming an important tool for adapting diffusion models to human preferences and task-specific objectives, but existing methods largely inherit policy-gradient machinery from large language models. Unlike autoregressive models, diffusion models do not provide tractable likelihoods for generated samples. As a result, current approaches either construct trajectory likelihoods from stochastic denoising transitions or approximate endpoint likelihoods with evidence lower bound, introducing additional computation and algorithmic complexity. We demonstrate that this likelihood-based machinery is not necessary for effective diffusion reward fine-tuning. We propose reward-based velocity matching (RVM), a simple trajectory-free update that acts directly on the velocity field. RVM reinforces directions associated with high-reward generations, suppresses those with low reward, and involves an optional anchor term controlling drift from a reference velocity. Notably, it provides a general framework that recovers recent fine-tuning methods, including RAM and DiffusionNFT, as special cases. Across various large-scale diffusion models reward fine-tuning tasks, RVM is competitive with or outperforms trajectory-based policy-gradient methods under substantially reduced training cost. We further find that, once the velocity update is simplified, the particular loss variant matters less than reward and anchor design. For video generation, standard preference rewards can favor visually clean but nearly static outputs; introducing a new dynamic-tracking reward that substantially improve motions while improving overall VBench performance. These results suggest that scalable reward fine-tuning for diffusion models is better posed in the native velocity representation than as likelihood-based policy optimization.

arXiv

Progressively Learning Heterogeneous Skills in a Unified Latent Space

Yue-Yi Zhang, MING GONG, Linpu He, Wei-Shi Zheng, Zhilin Zhao

We propose HetSkills, a novel framework designed to progressively learn heterogeneous skills within a unified latent space for physics-based character control. The core idea is to treat this latent space as a shared executable interface, enabling seamless integration of skills learned from diverse data sources, supervision forms, and tasks. HetSkills begins by learning a tracking skill that establishes a strong foundation in motion control and creates a shared motion decoder, which can be reused across tasks without the need for retraining or separate controllers. To prevent the text-to-motion skill from exploiting shortcut pathways instead of learning language semantics, we introduce motion intuition distillation to ground text-to-motion generation in language semantics and a task-guidance module that dynamically adjusts actions based on high-level language instructions. This enables HetSkills to preserve natural motion while continuously expanding its skill repertoire, making it highly adaptable for long-horizon tasks. Experimental results demonstrate the effectiveness in motion tracking, text-to-motion generation, motion completion, and downstream task adaptation, achieving impressive success rates even under challenging conditions.

arXiv

Is Visual Prompting All You Need? Studying VLM Spatial Reasoning under Progressive Visual Scaffolds

Lars Benedikt Kaesberg, Tianyu Yang, Florian Valentin Wunderlich, Terry Ruas, Daniel Kurzawe, Jan Philip Wahle, Bela Gipp

Vision-language models (VLMs) have advanced rapidly in multimodal reasoning, yet recent work shows that their failures often reflect an interaction between visual grounding and downstream reasoning. What remains less clear is how the visual presentation of a task shapes model performance and failure modes when the underlying reasoning problem is unchanged. We study this question in SPaRC, a benchmark for grid-based visual spatial planning, by introducing lightweight input-side scaffolds that preserve the visual modality while making spatial structure more accessible. Across multiple VLMs, these scaffolds improve task accuracy over the original visual setting by up to 34.0 percentage points and further complement GRPO-based training, yielding up to 4.6 additional accuracy points compared with near-zero gains on the original visual input. Analyses on both end-to-end task solving and object detection show that these gains are closely tied to reductions in grounding-related errors, while rule reasoning remains comparatively challenging. We find that visual presentation is a central factor that determines whether VLM benchmarks measure grounded perception, downstream reasoning, or a mixture of both.

arXiv

Label-efficient underwater image classification with logistic regression on frozen foundation model embeddings

Thomas Manuel Rost, Martina Figlia, F. Morgado-Dias, Marko Radeta

Underwater image classification is constrained by the cost of annotation and by the computational and methodological requirements of task-specific model development. We investigate whether frozen general-purpose foundation-model embeddings can reduce these requirements by extracting DINOv3 ViT-B/16 embeddings and training only a logistic regression classifier on the AQUA20 benchmark. We evaluate the approach across a range of annotation budgets, a repeated 80% training-subsample evaluation, and a full-training refit. With only 13 labelled images per category, corresponding to approximately 4% of the benchmark's official training partition, mean macro F1 reaches 81.8%; with 144 images per category it reaches 88.5%, compared to the published fully supervised ConvNeXt point estimate of 88.9% obtained with the complete training set (benchmark results reported without run-to-run variability). Using all official training labels, macro F1 reaches 91.5% (bootstrap 95% CI: 89.0-93.7%). Sensitivity analyses show that the main findings remain stable across ordinary downstream implementation choices, and persist after removing duplicate and near-duplicate test images identified in an audit of the official split. Preliminary evaluation on a second dataset suggests that overall performance level and the shape of the label efficiency curve are not unique to the AQUA20 dataset. Because the DINOv3 backbone remains frozen and only the downstream classifier is fitted, the approach avoids task-specific neural-network training and can be executed on commodity hardware. These findings establish linear classification on frozen foundation-model embeddings as a practical baseline for label-efficient underwater image classification.

arXiv

RT-NeuS: Towards Real-Time Neuro-Symbolic Video Understanding via Adaptive Temporal Verification

Shawn Liang, Sahil Shah, Chengwei Zhou, S P Sharan, Harsh Goel, Arnab Sanyal, Sandeep Chinchali, Gourav Datta

Long-form video question answering (LVQA) requires answering natural-language queries about videos spanning minutes to hours, demanding temporal reasoning across thousands of frames. Standard vision-language models (VLMs) struggle with this task: their fixed frame budgets force aggressive downsampling that misses the temporal structure that complex queries depend on. Neuro-symbolic approaches address this by decomposing queries into atomic propositions, translating them into temporal logic specifications, and applying formal model checking to retrieve segments satisfying the specification. This yields up to 10% higher accuracy on temporally complex benchmarks, with interpretability and formal guarantees. However, constructing the video automaton requires grounding every proposition at every frame window via VLM calls, resulting in up to 130x slower inference than standard VLM prompting. We present RT-NeuS, a framework that preserves the accuracy and formal guarantees of temporal-logic-guided LVQA while closing this latency gap. RT-NeuS introduces coarse-to-fine adaptive sampling to identify the small set of query-relevant, visually distinct frames, and batched proposition detection with KV-cache reuse to evaluate all propositions per window in a single forward pass. We derive latency upper bounds as a function of video length, proposition count, and sampling density. Experiments on LongVideoBench, Video-MME, and MLVU reduce inference latency by up to 13x on a single NVIDIA H200 GPU, while matching or exceeding prior neuro-symbolic accuracy.

arXiv

Unlocking the power of partnership: How humans and machines can work together to improve face recognition

P. Jonathon Phillips, Geraldine Jeckeln, Amy N. Yates, Carina A. Hahn, Peter C. Fontana, Alice J. O'Toole

Human review of consequential decisions by face recognition algorithms creates a collaborative human-machine system. We establish the circumstances under which combining human and machine face identification decisions improves accuracy. Using data from expert and non-expert face identifiers, we show that the benefits of human-human and human-machine collaborations increase as the difference in baseline accuracy between collaborators decreases. This rule holds across a wide range of baseline abilities, from novices to professional forensic face examiners. An important consequence of the rule is that people who are substantially less accurate than the machine, can actually improve decision accuracy when they collaborate with the machine. In a group of individual people collaborating with a machine, "intelligent human-machine fusion" was implemented by selecting people with the potential to increase collaborative accuracy. Performance with intelligent human-machine fusion was more accurate than either the machine operating alone or fusing all humans with the machine. Eliminating the machine from consideration yielded less predictable results, with average performance at or below intelligent human-machine collaboration. However, intelligent human-machine fusion was consistently more effective at minimizing the impact of low-performing humans on accuracy. The results demonstrate a meaningful role for both humans and machines in assuring accurate face identification.

arXiv

Adaptive Multi-Mode Out-of-Distribution Detection for Trajectory Prediction in Autonomous Vehicles

Tongfei Guo, Lili Su

Trustworthy trajectory prediction grounds autonomous vehicle (AV) safety, yet deployed models inevitably face out-of-distribution (OOD) scenes. Prior AV OOD detection targets perception, but planners act on predicted futures rather than raw scenes, so erroneous forecasts can slip past frame-level checks and corrupt control. We therefore tackle OOD detection at the trajectory-prediction level. Our analysis of real-world benchmarks reveals that prediction errors are often multi-modal, exhibiting distinct low- and high-error modes that evolve with open-world driving context. Observing this, we propose Mode-Aware CUSUM, which explicitly models multiple error modes while retaining the efficiency and general compatibility of classical CUSUM. By dynamically identifying the active error mode and adapting detection thresholds, our method enables robust monitoring across heterogeneous conditions. Experiments on large-scale trajectory benchmarks demonstrate consistent reductions in detection delay and false alarms.

arXiv

Intrinsic PAPR: Tackling Misattribution in 3D Intrinsic Decomposition via Proximity Attention Point Rendering

Alireza Moazeni, Shichong Peng, Yanshu Zhang, Chirag Vashist, Ke Li

Recent point-based intrinsic decomposition and inverse rendering methods have advanced the modelling of the shading and albedo of 3D scenes. However, we identify a fundamental limitation: these methods suffer from a misattribution issue, where individual primitives learn incorrect appearance features despite producing correct aggregated renderings. We show that the root cause lies in volume rendering, which aggregates translucent primitives along each ray and only supervises the final colour, preventing direct supervision of individual primitive features. To address this, we propose Intrinsic PAPR, a robust intrinsic decomposition framework which leverages Proximity Attention Point Rendering (PAPR) to enable direct per-point supervision. Unlike volume rendering approaches, PAPR eliminates translucent primitives and directly predicts appearance at ray-surface intersections, enabling accurate supervision to the feature of each individual point. Our method incorporates a 2D albedo prior adapted with conditional Implicit Maximum Likelihood Estimation (cIMLE) to handle monocular ambiguities, and employs a space carving loss to ensure multi-view consistency. Extensive evaluations on synthetic and real-world datasets demonstrate that Intrinsic PAPR outperforms point-based inverse rendering, NeRF-based intrinsic decomposition, and diffusion-based PBR methods in novel view synthesis and albedo estimation while resolving the misattribution issue.

arXiv

RACR-MIL: Rank-aware contextual reasoning for weakly supervised grading of squamous cell carcinoma using whole slide images

Anirudh Choudhary, Mosbah Aouad, Krishnakant Saboo, Angelina Hwang, Jacob Kechter, Blake Bordeaux, Puneet Bhullar, David DiCaudo, Steven Nelson, Nneka Comfere, Emma Johnson, Olayemi Sokumbi, Jason Sluzevich, Leah Swanson, Dennis Murphree, Aaron Mangold, Ravishankar Iyer

Squamous cell carcinoma (SCC) is one of the most common cancer subtype, with an increasing incidence and a significant impact on cancer-related mortality. SCC grading using whole slide images is inherently challenging due to the lack of a standardized grading protocol and substantial tissue heterogeneity. We propose RACR-MIL, a weakly-supervised SCC grading approach that achieves robust generalization across multiple anatomies (skin, head & neck, lung). RACR-MIL is an attention-based multiple-instance learning framework that introduces two key innovations for learning grade-specific contextual representations: (1) a hybrid WSI graph that captures both local tissue context and non-local phenotypic dependencies between tumor regions, and (2) rank-ordering constraints on the attention mechanism that encourage consistent prioritization of higher-grade tumor regions and improve region-level grade confidence, aligning with pathologist's diagnostic process. Our model achieves state-of-the-art performance across multiple SCC datasets, achieving 3-9% improvements over existing methods and up to 10% improvement in tumor localization. In a pilot study, pathologists reported that RACR-MIL improved grading efficiency in 60% of cases, underscoring its potential as a clinically viable cancer diagnosis and grading assistant.

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