arXiv:2605.25396v1 Announce Type: cross Abstract: Reliable quality control (QC) of ultrasound images is essential for both real-time acquisition guidance and retrospective clinical audit, yet existing approaches rely heavily on per-plane annotations, or employ pseudo-labeling prone to systematic bias under spatial deformations inherent in clinical acquisition. We present STRIQ, a registration-driven framework that recasts annotation-free US plane quality control as a subspace-guided consistency measurement problem. Specifically, STRIQ introduces a Latent Registration Aligner (LRA) to establish hierarchical feature space correspondences between query images and variance-driven anchors, which are autonomously distilled from unlabeled data via a variance spectrum criterion to serve as structurally stable prototypes. To further disambiguate anatomical planes and mitigate negative knowledge transfer, we propose an Orthogonal Knowledge Subspace (OKS) module. The OKS decomposes plane-specific representations into mutually orthogonal subspaces, enabling fine-grained expert collaboration while preventing inter-plane interference, ensuring that the quality metric is grounded in principled subspace proximity. Extensive experiments on the in-house US4QA and public CAMUS datasets demonstrate that STRIQ achieves state-of-the-art correlation with clinical quality scores, establishing a new paradigm for annotation-free, real-time reliable ultrasound quality control. Our code is available at https://github.com/zhcz328/STRIQ.

arXiv:2605.25402v1 Announce Type: cross Abstract: Self-supervised pre-training paradigm has gained increasing prominence for learning transferable representations in medical imaging, yet existing methods for ultrasound (US) images operate at the image or frame level, overlooking the anatomical context for clinical-aligned representation learning. In this work, we propose an anatomy-anchored ultrasound self-supervision framework ANAUS that shifts representation learning from generic visual regions to clinically meaningful anatomical structures. Utilizing a learnable latent prompt engine alongside a one-time domain adaptation on existing public image--mask pairs, we empower the LP-SAM module to achieve annotation-free anatomy delineation at scale. Building upon this anatomical grounding, we propose a dual-policy self-supervised learning paradigm consisting of inter-view semantics-aware anatomy-separating alignment and contextual core-region prediction to enhance representation learning. Specifically, the former enforces feature invariance within identical anatomical regions while promoting discriminability across distinct structures; the latter compels the model to reconstruct corrupted regions, thereby capturing fine-grained structural details. Extensive evaluations on six public datasets demonstrate that \ours{} consistently outstrips current state-of-the-art methods while maintaining the computational efficiency essential for clinical deployment. Code is available at https://github.com/zhcz328/ANAUS.

arXiv:2603.23085v1 Announce Type: new Abstract: Vision-Language Models (VLMs) have enabled interpretable medical diagnosis by integrating visual perception with linguistic reasoning. Yet, existing medical chain-of-thought (CoT) models lack explicit mechanisms to represent and enforce causal reasoning, leaving them vulnerable to spurious correlations and limiting their clinical reliability. We pinpoint three core challenges in medical CoT reasoning: how to adaptively trigger causal correction, construct high-quality causal-spurious contrastive samples, and maintain causal consistency across reasoning trajectories. To address these challenges, we propose MedCausalX, an end-to-end framework explicitly models causal reasoning chains in medical VLMs. We first introduce the CRMed dataset providing fine-grained anatomical annotations, structured causal reasoning chains, and counterfactual variants that guide the learning of causal relationships beyond superficial correlations. Building upon CRMed, MedCausalX employs a two-stage adaptive reflection architecture equipped with $\langle$causal$\rangle$ and $\langle$verify$\rangle$ tokens, enabling the model to autonomously determine when and how to perform causal analysis and verification. Finally, a trajectory-level causal correction objective optimized through error-attributed reinforcement learning refines the reasoning chain, allowing the model to distinguish genuine causal dependencies from shortcut associations. Extensive experiments on multiple benchmarks show that MedCausalX consistently outperforms state-of-the-art methods, improving diagnostic consistency by +5.4 points, reducing hallucination by over 10 points, and attaining top spatial grounding IoU, thereby setting a new standard for causally grounded medical reasoning.