Daily Papers

Despite recent advances in deep generative modeling, skin lesion classification systems remain constrained by the limited availability of large, diverse, and well-annotated clinical datasets, resulting in class imbalance between benign and malignant lesions and consequently reduced generalization performance. We introduce DermaFlux, a rectified flow-based text-to-image generative framework that synthesizes clinically grounded skin lesion images from natural language descriptions of dermatological attributes. Built upon Flux.1, DermaFlux is fine-tuned using parameter-efficient Low-Rank Adaptation (LoRA) on a large curated collection of publicly available clinical image datasets. We construct image-text pairs using synthetic textual captions generated by Llama 3.2, following established dermatological criteria including lesion asymmetry, border irregularity, and color variation. Extensive experiments demonstrate that DermaFlux generates diverse and clinically meaningful dermatology images that improve binary classification performance by up to 6% when augmenting small real-world datasets, and by up to 9% when classifiers are trained on DermaFlux-generated synthetic images rather than diffusion-based synthetic images. Our ImageNet-pretrained ViT fine-tuned with only 2,500 real images and 4,375 DermaFlux-generated samples achieves 78.04% binary classification accuracy and an AUC of 0.859, surpassing the next best dermatology model by 8%.

Focal cortical dysplasia (FCD) lesions in epilepsy FLAIR MRI are subtle and scarce, making joint image--mask generative modeling prone to instability and memorization. We propose SLIM-Diff, a compact joint diffusion model whose main contributions are (i) a single shared-bottleneck U-Net that enforces tight coupling between anatomy and lesion geometry from a 2-channel image+mask representation, and (ii) loss-geometry tuning via a tunable L_p objective. As an internal baseline, we include the canonical DDPM-style objective (ε-prediction with L_2 loss) and isolate the effect of prediction parameterization and L_p geometry under a matched setup. Experiments show that x_0-prediction is consistently the strongest choice for joint synthesis, and that fractional sub-quadratic penalties (L_{1.5}) improve image fidelity while L_2 better preserves lesion mask morphology. Our code and model weights are available in https://github.com/MarioPasc/slim-diff

Diffusion models have achieved significant success in both natural image and medical image domains, encompassing a wide range of applications. Previous investigations in medical images have often been constrained to specific anatomical regions, particular applications, and limited datasets, resulting in isolated diffusion models. This paper introduces a diffusion-based foundation model to address a diverse range of medical image tasks, namely MedDiff-FM. MedDiff-FM leverages 3D CT images from multiple publicly available datasets, covering anatomical regions from head to abdomen, to pre-train a diffusion foundation model, and explores the capabilities of the diffusion foundation model across a variety of application scenarios. The diffusion foundation model handles multi-level integrated image processing both at the image-level and patch-level, utilizes position embedding to establish multi-level spatial relationships, and leverages region classes and anatomical structures to capture certain anatomical regions. MedDiff-FM manages several downstream tasks seamlessly, including image denoising, anomaly detection, and image synthesis. MedDiff-FM is also capable of performing super-resolution, lesion generation, and lesion inpainting by rapidly fine-tuning the diffusion foundation model using ControlNet with task-specific conditions. The experimental results demonstrate the effectiveness of MedDiff-FM in addressing diverse downstream medical image tasks.

The flatfish is a major farmed species consumed globally in large quantities. However, due to the densely populated farming environment, flatfish are susceptible to lesions and diseases, making early lesion detection crucial. Traditionally, lesions were detected through visual inspection, but observing large numbers of fish is challenging. Automated approaches based on deep learning technologies have been widely used to address this problem, but accurate detection remains difficult due to the diversity of the fish and the lack of a fish lesion and disease dataset. This study augments fish lesion images using generative adversarial networks and image harmonization methods. Next, lesion detectors are trained separately for three body parts (head, fins, and body) to address individual lesions properly. Additionally, a flatfish lesion and disease image dataset, called FlatIMG, is created and verified using the proposed methods on the dataset. A flash salmon lesion dataset is also tested to validate the generalizability of the proposed methods. The results achieved 12% higher performance than the baseline framework. This study is the first attempt to create a high-quality flatfish lesion image dataset with detailed annotations and propose an effective lesion detection framework. Automatic lesion and disease monitoring can be achieved in farming environments using the proposed methods and dataset.

Previous research on radiology report generation has made significant progress in terms of increasing the clinical accuracy of generated reports. In this paper, we emphasize another crucial quality that it should possess, i.e., inter-report consistency, which refers to the capability of generating consistent reports for semantically equivalent radiographs. This quality is even of greater significance than the overall report accuracy in terms of ensuring the system's credibility, as a system prone to providing conflicting results would severely erode users' trust. Regrettably, existing approaches struggle to maintain inter-report consistency, exhibiting biases towards common patterns and susceptibility to lesion variants. To address this issue, we propose ICON, which improves the inter-report consistency of radiology report generation. Aiming at enhancing the system's ability to capture the similarities in semantically equivalent lesions, our approach involves first extracting lesions from input images and examining their characteristics. Then, we introduce a lesion-aware mix-up augmentation technique to ensure that the representations of the semantically equivalent lesions align with the same attributes, by linearly interpolating them during the training phase. Extensive experiments on three publicly available chest X-ray datasets verify the effectiveness of our approach, both in terms of improving the consistency and accuracy of the generated reports.

Medical images and radiology reports are crucial for diagnosing medical conditions, highlighting the importance of quantitative analysis for clinical decision-making. However, the diversity and cross-source heterogeneity of these data challenge the generalizability of current data-mining methods. Multimodal large language models (MLLMs) have recently transformed many domains, significantly affecting the medical field. Notably, Gemini-Vision-series (Gemini) and GPT-4-series (GPT-4) models have epitomized a paradigm shift in Artificial General Intelligence (AGI) for computer vision, showcasing their potential in the biomedical domain. In this study, we evaluated the performance of the Gemini, GPT-4, and 4 popular large models for an exhaustive evaluation across 14 medical imaging datasets, including 5 medical imaging categories (dermatology, radiology, dentistry, ophthalmology, and endoscopy), and 3 radiology report datasets. The investigated tasks encompass disease classification, lesion segmentation, anatomical localization, disease diagnosis, report generation, and lesion detection. Our experimental results demonstrated that Gemini-series models excelled in report generation and lesion detection but faces challenges in disease classification and anatomical localization. Conversely, GPT-series models exhibited proficiency in lesion segmentation and anatomical localization but encountered difficulties in disease diagnosis and lesion detection. Additionally, both the Gemini series and GPT series contain models that have demonstrated commendable generation efficiency. While both models hold promise in reducing physician workload, alleviating pressure on limited healthcare resources, and fostering collaboration between clinical practitioners and artificial intelligence technologies, substantial enhancements and comprehensive validations remain imperative before clinical deployment.

Quantitative susceptibility maps from magnetic resonance images can provide both prognostic and diagnostic information in multiple sclerosis, a neurodegenerative disease characterized by the formation of lesions in white matter brain tissue. In particular, susceptibility maps provide adequate contrast to distinguish between "rim" lesions, surrounded by deposited paramagnetic iron, and "non-rim" lesion types. These paramagnetic rim lesions (PRLs) are an emerging biomarker in multiple sclerosis. Much effort has been devoted to both detection and segmentation of such lesions to monitor longitudinal change. As paramagnetic rim lesions are rare, addressing this problem requires confronting the class imbalance between rim and non-rim lesions. We produce synthetic quantitative susceptibility maps of paramagnetic rim lesions and show that inclusion of such synthetic data improves classifier performance and provide a multi-channel extension to generate accompanying contrasts and probabilistic segmentation maps. We exploit the projection capability of our trained generative network to demonstrate a novel denoising approach that allows us to train on ambiguous rim cases and substantially increase the minority class. We show that both synthetic lesion synthesis and our proposed rim lesion label denoising method best approximate the unseen rim lesion distribution and improve detection in a clinically interpretable manner. We release our code and generated data at https://github.com/agr78/PRLx-GAN upon publication.

This study explores the utilization of Dermatoscopic synthetic data generated through stable diffusion models as a strategy for enhancing the robustness of machine learning model training. Synthetic data generation plays a pivotal role in mitigating challenges associated with limited labeled datasets, thereby facilitating more effective model training. In this context, we aim to incorporate enhanced data transformation techniques by extending the recent success of few-shot learning and a small amount of data representation in text-to-image latent diffusion models. The optimally tuned model is further used for rendering high-quality skin lesion synthetic data with diverse and realistic characteristics, providing a valuable supplement and diversity to the existing training data. We investigate the impact of incorporating newly generated synthetic data into the training pipeline of state-of-art machine learning models, assessing its effectiveness in enhancing model performance and generalization to unseen real-world data. Our experimental results demonstrate the efficacy of the synthetic data generated through stable diffusion models helps in improving the robustness and adaptability of end-to-end CNN and vision transformer models on two different real-world skin lesion datasets.

Generating automated reports for 3D positron emission tomography (PET) is an important and challenging task in medical imaging. PET plays a vital role in oncology, but automating report generation is difficult due to the complexity of whole-body 3D volumes, the wide range of potential clinical findings, and the limited availability of annotated datasets. To address these challenges, we introduce PETARSeg-11K, the first large-scale, publicly available dataset that provides lesion-level correspondence between 3D PET/CT volumes and free-text radiological findings. It comprises 11,356 lesion descriptions paired with 3D segmentations. Second, we propose PETAR-4B, a 3D vision-language model designed for mask-aware, spatially grounded PET/CT reporting. PETAR-4B jointly encodes PET, CT, and 3D lesion segmentation masks, using a 3D focal prompt to capture fine-grained details of lesions that normally comprise less than 0.1% of the volume. Evaluations using automated metrics show PETAR-4B substantially outperforming all 2D and 3D baselines. A human study involving five physicians -- the first of its kind for automated PET reporting -- confirms the model's clinical utility and establishes correlations between automated metrics and expert judgment. This work provides a foundational dataset and a novel architecture, advancing 3D medical vision-language understanding in PET.

False negatives remain a critical limitation of computer-aided diagnosis (CAD) systems for breast cancer screening due to delayed detection and treatment. To address this issue, we propose a counterfactual data augmentation strategy that generates healthy mammograms by "erasing" lesions from anomalous images, thereby enriching the training distribution. We train a Denoising Diffusion Probabilistic Model on BI-RADS 1 (healthy) mammograms and use a RePaint-based sampling strategy to inpaint realistic normal tissue within annotated lesion bounding boxes. The resulting healthy counterfactuals replace annotated lesion regions with realistic healthy tissue while preserving patient-specific anatomical structure, as supported by similarity metrics between real and generated images. Image realism was further assessed by radiologists and found to be consistent with the original dataset quality. We evaluate counterfactual augmentation across four representative classifier architectures: a convolutional neural network (ConvNeXt), a vision transformer (ViT), a vision-language model pre-trained on mammogram-report pairs (Mammo-CLIP) and a multi-scale attention-based multiple-instance learning framework (FPN-MIL). Experiments conducted on the VinDr-Mammo dataset show improvements in sensitivity across all architectures, particularly at 80\% fixed specificity, contributing towards more reliable CAD systems for breast cancer. Code is available at: https://github.com/ines03garcia/diffusion-based-counterfactual-generation.

Millions of melanocytic skin lesions are examined by pathologists each year, the majority of which concern common nevi (i.e., ordinary moles). While most of these lesions can be diagnosed in seconds, writing the corresponding pathology report is much more time-consuming. Automating part of the report writing could, therefore, alleviate the increasing workload of pathologists. In this work, we develop a vision-language model specifically for the pathology domain of cutaneous melanocytic lesions. The model follows the Contrastive Captioner framework and was trained and evaluated using a melanocytic lesion dataset of 42,512 H&E-stained whole slide images and 19,645 corresponding pathology reports. Our results show that the quality scores of model-generated reports were on par with pathologist-written reports for common nevi, assessed by an expert pathologist in a reader study. While report generation revealed to be more difficult for rare melanocytic lesion subtypes, the cross-modal retrieval performance for these cases was considerably better.

Accurate dermatological diagnosis naturally necessitates equitable performance across diverse populations, yet a systematic lack of expertly annotated images, especially for underrepresented skin tones and rare diseases, impedes progress toward measurably fair methods. We introduce cgDDI (Controllable Generation of Diverse Dermatological Imagery), a hybrid framework that (1) synthesizes realistic healthy skin samples without disturbing other input properties, (2) maps single-sample rare lesions onto novel skin-tones and locations non-parametrically, and (3) allows for efficient parametric generation with as few as 10 training samples. The framework supports both human and automated segmentation masking, enabling scalability to datasets without pre-made lesion masks. We grow a 656-image dataset by more than 400x and validate across two datasets: biopsy-confirmed Diverse Dermatology Images (DDI) and expert-verified Fitzpatrick17k (F17k). On the DDI benchmark, we achieve malignancy classification accuracy of 86.4% under synthetic-only training and 90.9% state-of-the-art performance with real data fine-tuning, alongside leading fairness metrics. Cross-dataset experiments show +13.9% accuracy improvements on unseen F17k data despite minimal disease overlap. We openly release 266k+ synthetic images, code, and generative models to further support fairness research at https://github.com/hectorcarrion/ControllableGenDDI.

Prostate cancer, a growing global health concern, necessitates precise diagnostic tools, with Magnetic Resonance Imaging (MRI) offering high-resolution soft tissue imaging that significantly enhances diagnostic accuracy. Recent advancements in explainable AI and representation learning have significantly improved prostate cancer diagnosis by enabling automated and precise lesion classification. However, existing explainable AI methods, particularly those based on frameworks like generative adversarial networks (GANs), are predominantly developed for natural image generation, and their application to medical imaging often leads to suboptimal performance due to the unique characteristics and complexity of medical image. To address these challenges, our paper introduces three key contributions. First, we propose ProjectedEx, a generative framework that provides interpretable, multi-attribute explanations, effectively linking medical image features to classifier decisions. Second, we enhance the encoder module by incorporating feature pyramids, which enables multiscale feedback to refine the latent space and improves the quality of generated explanations. Additionally, we conduct comprehensive experiments on both the generator and classifier, demonstrating the clinical relevance and effectiveness of ProjectedEx in enhancing interpretability and supporting the adoption of AI in medical settings. Code will be released at https://github.com/Richardqiyi/ProjectedEx

Magnetic resonance imaging (MRI) is a central modality for stroke imaging. It is used upon patient admission to make treatment decisions such as selecting patients for intravenous thrombolysis or endovascular therapy. MRI is later used in the duration of hospital stay to predict outcome by visualizing infarct core size and location. Furthermore, it may be used to characterize stroke etiology, e.g. differentiation between (cardio)-embolic and non-embolic stroke. Computer based automated medical image processing is increasingly finding its way into clinical routine. Previous iterations of the Ischemic Stroke Lesion Segmentation (ISLES) challenge have aided in the generation of identifying benchmark methods for acute and sub-acute ischemic stroke lesion segmentation. Here we introduce an expert-annotated, multicenter MRI dataset for segmentation of acute to subacute stroke lesions. This dataset comprises 400 multi-vendor MRI cases with high variability in stroke lesion size, quantity and location. It is split into a training dataset of n=250 and a test dataset of n=150. All training data will be made publicly available. The test dataset will be used for model validation only and will not be released to the public. This dataset serves as the foundation of the ISLES 2022 challenge with the goal of finding algorithmic methods to enable the development and benchmarking of robust and accurate segmentation algorithms for ischemic stroke.

Multiphasic contrast-enhanced CT (CECT) is widely used for abdominal lesion characterization, yet it carries inherent risks of contrast-induced nephropathy, escalates acquisition burden, and heavily contributes to radiologist workload. To address these challenges, we introduce a novel multi-center benchmark for multi-organ abdominal disease diagnosis and automated radiology report generation, which learns to synthesize contrast-enhanced findings from single-phase non-contrast CT (NCCT). To support this, we curated a large-scale dataset of paired NCCT-CECT studies and their corresponding contrast-enhanced radiology reports from two centers, partitioned into internal sets and an external validation cohort. Under a unified evaluation protocol, we benchmarked five contemporary deep learning architectures encompassing chest-specific, abdomen-specific, and general-purpose multimodal domains. Extensive experiments demonstrate that NCCT retains diagnostic signals, achieving an average multi-organ AUC of 69.1% on the internal cohort and 63.1% on the external cohort, respectively. By releasing this dataset and standardized benchmark publicly, this study aims to catalyze future research into safer, resource-efficient, and globally accessible contrast-free abdominal imaging workflows. Code is available at: https://github.com/xmed-lab/TriALS-Report.

Radiology reporting generative AI holds significant potential to alleviate clinical workloads and streamline medical care. However, achieving high clinical accuracy is challenging, as radiological images often feature subtle lesions and intricate structures. Existing systems often fall short, largely due to their reliance on fixed size, patch-level image features and insufficient incorporation of pathological information. This can result in the neglect of such subtle patterns and inconsistent descriptions of crucial pathologies. To address these challenges, we propose an innovative approach that leverages pathology-aware regional prompts to explicitly integrate anatomical and pathological information of various scales, significantly enhancing the precision and clinical relevance of generated reports. We develop an anatomical region detector that extracts features from distinct anatomical areas, coupled with a novel multi-label lesion detector that identifies global pathologies. Our approach emulates the diagnostic process of radiologists, producing clinically accurate reports with comprehensive diagnostic capabilities. Experimental results show that our model outperforms previous state-of-the-art methods on most natural language generation and clinical efficacy metrics, with formal expert evaluations affirming its potential to enhance radiology practice.

Patient data from real-world clinical practice often suffers from data scarcity and long-tail imbalances, leading to biased outcomes or algorithmic unfairness. This study addresses these challenges by generating lesion-containing image-segmentation pairs from lesion-free images. Previous efforts in medical imaging synthesis have struggled with separating lesion information from background, resulting in low-quality backgrounds and limited control over the synthetic output. Inspired by diffusion-based image inpainting, we propose LeFusion, a lesion-focused diffusion model. By redesigning the diffusion learning objectives to focus on lesion areas, we simplify the learning process and improve control over the output while preserving high-fidelity backgrounds by integrating forward-diffused background contexts into the reverse diffusion process. Additionally, we tackle two major challenges in lesion texture synthesis: 1) multi-peak and 2) multi-class lesions. We introduce two effective strategies: histogram-based texture control and multi-channel decomposition, enabling the controlled generation of high-quality lesions in difficult scenarios. Furthermore, we incorporate lesion mask diffusion, allowing control over lesion size, location, and boundary, thus increasing lesion diversity. Validated on 3D cardiac lesion MRI and lung nodule CT datasets, LeFusion-generated data significantly improves the performance of state-of-the-art segmentation models, including nnUNet and SwinUNETR. Code and model are available at https://github.com/M3DV/LeFusion.

Skin carcinoma is the most prevalent form of cancer globally, accounting for over $8 billion in annual healthcare expenditures. In clinical settings, physicians document patient visits using detailed SOAP (Subjective, Objective, Assessment, and Plan) notes. However, manually generating these notes is labor-intensive and contributes to clinician burnout. In this work, we propose a weakly supervised multimodal framework to generate clinically structured SOAP notes from limited inputs, including lesion images and sparse clinical text. Our approach reduces reliance on manual annotations, enabling scalable, clinically grounded documentation while alleviating clinician burden and reducing the need for large annotated data. Our method achieves performance comparable to GPT-4o, Claude, and DeepSeek Janus Pro across key clinical relevance metrics. To evaluate clinical quality, we introduce two novel metrics MedConceptEval and Clinical Coherence Score (CCS) which assess semantic alignment with expert medical concepts and input features, respectively.

Automated diagnostic systems (ADS) have shown significant potential in the early detection of polyps during endoscopic examinations, thereby reducing the incidence of colorectal cancer. However, due to high annotation costs and strict privacy concerns, acquiring high-quality endoscopic images poses a considerable challenge in the development of ADS. Despite recent advancements in generating synthetic images for dataset expansion, existing endoscopic image generation algorithms failed to accurately generate the details of polyp boundary regions and typically required medical priors to specify plausible locations and shapes of polyps, which limited the realism and diversity of the generated images. To address these limitations, we present Polyp-Gen, the first full-automatic diffusion-based endoscopic image generation framework. Specifically, we devise a spatial-aware diffusion training scheme with a lesion-guided loss to enhance the structural context of polyp boundary regions. Moreover, to capture medical priors for the localization of potential polyp areas, we introduce a hierarchical retrieval-based sampling strategy to match similar fine-grained spatial features. In this way, our Polyp-Gen can generate realistic and diverse endoscopic images for building reliable ADS. Extensive experiments demonstrate the state-of-the-art generation quality, and the synthetic images can improve the downstream polyp detection task. Additionally, our Polyp-Gen has shown remarkable zero-shot generalizability on other datasets. The source code is available at https://github.com/CUHK-AIM-Group/Polyp-Gen.

Counterfactual medical image generation effectively addresses data scarcity and enhances the interpretability of medical images. However, due to the complex and diverse pathological features of medical images and the imbalanced class distribution in medical data, generating high-quality and diverse medical images from limited data is significantly challenging. Additionally, to fully leverage the information in limited data, such as anatomical structure information and generate more structurally stable medical images while avoiding distortion or inconsistency. In this paper, in order to enhance the clinical relevance of generated data and improve the interpretability of the model, we propose a novel medical image generation framework, which generates independent pathological and structural features based on causal disentanglement and utilizes text-guided modeling of pathological features to regulate the generation of counterfactual images. First, we achieve feature separation through causal disentanglement and analyze the interactions between features. Here, we introduce group supervision to ensure the independence of pathological and identity features. Second, we leverage a diffusion model guided by pathological findings to model pathological features, enabling the generation of diverse counterfactual images. Meanwhile, we enhance accuracy by leveraging a large language model to extract lesion severity and location from medical reports. Additionally, we improve the performance of the latent diffusion model on long-tailed categories through initial noise optimization.

The evaluation of vision-language models (VLMs) for chest X-ray (CXR) analysis has largely been limited to disease-presence classification without visual grounding. Such evaluations fail to verify the expert-level lesion perception necessary to ensure the clinical reliability of VLMs. To address these limitations, we introduce CheXpercept, a sequential, multi-level perception benchmark that mirrors a radiologist's cognitive workflow across coarse-level detection, fine-level contour evaluation and revision, and semantic-level attribute extraction. To ensure high clinical fidelity at scale, we construct the dataset using a semi-automated generation pipeline paired with a review by six medical experts. CheXpercept contains 10,400 QA items derived from 2,100 CXRs, covering seven clinically critical pulmonary and cardiac lesions. To demonstrate the current landscape of VLM perception, we benchmark 14 general and medical VLMs on CheXpercept. The models achieve adequate performance only at the coarse level, with accuracy degrading precipitously on deeper visual tasks. Notably, medical VLMs show almost no perceptual advantage over their general-domain counterparts, highlighting a systemic flaw in current domain adaptation. The code and dataset will be publicly available.

The scarcity of high-quality segmentation masks remains a major bottleneck for medical image analysis, particularly in non-contrast CT (NCCT) neuroimaging, where manual annotation is costly and variable. To address this limitation, we propose an anatomy-preserving generative framework for the unconditional synthesis of multi-class brain segmentation masks, including ischemic infarcts. The proposed approach combines a variational autoencoder trained exclusively on segmentation masks to learn an anatomical latent representation, with a diffusion model operating in this latent space to generate new samples from pure noise. At inference, synthetic masks are obtained by decoding denoised latent vectors through the frozen VAE decoder, with optional coarse control over lesion presence via a binary prompt. Qualitative results show that the generated masks preserve global brain anatomy, discrete tissue semantics, and realistic variability, while avoiding the structural artifacts commonly observed in pixel-space generative models. Overall, the proposed framework offers a simple and scalable solution for anatomy-aware mask generation in data-scarce medical imaging scenarios.

Development of artificial intelligence (AI) techniques in medical imaging requires access to large-scale and diverse datasets for training and evaluation. In dermatology, obtaining such datasets remains challenging due to significant variations in patient populations, illumination conditions, and acquisition system characteristics. In this work, we propose S-SYNTH, the first knowledge-based, adaptable open-source skin simulation framework to rapidly generate synthetic skin, 3D models and digitally rendered images, using an anatomically inspired multi-layer, multi-component skin and growing lesion model. The skin model allows for controlled variation in skin appearance, such as skin color, presence of hair, lesion shape, and blood fraction among other parameters. We use this framework to study the effect of possible variations on the development and evaluation of AI models for skin lesion segmentation, and show that results obtained using synthetic data follow similar comparative trends as real dermatologic images, while mitigating biases and limitations from existing datasets including small dataset size, lack of diversity, and underrepresentation.

Vision-language models in pathology enable multimodal case retrieval and automated report generation. Many of the models developed so far, however, have been trained on pathology reports that include information which cannot be inferred from paired whole slide images (e.g., patient history), potentially leading to hallucinated sentences in generated reports. To this end, we investigate how the selection of information from pathology reports for vision-language modeling affects the quality of the multimodal representations and generated reports. More concretely, we compare a model trained on full reports against a model trained on preprocessed reports that only include sentences describing the cell and tissue appearances based on the H&E-stained slides. For the experiments, we built upon the BLIP-2 framework and used a cutaneous melanocytic lesion dataset of 42,433 H&E-stained whole slide images and 19,636 corresponding pathology reports. Model performance was assessed using image-to-text and text-to-image retrieval, as well as qualitative evaluation of the generated reports by an expert pathologist. Our results demonstrate that text preprocessing prevents hallucination in report generation. Despite the improvement in the quality of the generated reports, training the vision-language model on full reports showed better cross-modal retrieval performance.

Medical imaging technologies, including computed tomography (CT) or chest X-Ray (CXR), are largely employed to facilitate the diagnosis of the COVID-19. Since manual report writing is usually too time-consuming, a more intelligent auxiliary medical system that could generate medical reports automatically and immediately is urgently needed. In this article, we propose to use the medical visual language BERT (Medical-VLBERT) model to identify the abnormality on the COVID-19 scans and generate the medical report automatically based on the detected lesion regions. To produce more accurate medical reports and minimize the visual-and-linguistic differences, this model adopts an alternate learning strategy with two procedures that are knowledge pretraining and transferring. To be more precise, the knowledge pretraining procedure is to memorize the knowledge from medical texts, while the transferring procedure is to utilize the acquired knowledge for professional medical sentences generations through observations of medical images. In practice, for automatic medical report generation on the COVID-19 cases, we constructed a dataset of 368 medical findings in Chinese and 1104 chest CT scans from The First Affiliated Hospital of Jinan University, Guangzhou, China, and The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China. Besides, to alleviate the insufficiency of the COVID-19 training samples, our model was first trained on the large-scale Chinese CX-CHR dataset and then transferred to the COVID-19 CT dataset for further fine-tuning. The experimental results showed that Medical-VLBERT achieved state-of-the-art performances on terminology prediction and report generation with the Chinese COVID-19 CT dataset and the CX-CHR dataset. The Chinese COVID-19 CT dataset is available at https://covid19ct.github.io/.

Medical vision-language models (VLMs) have shown increasing potential for clinical image interpretation, including lesion detection and report generation. However, their practical utility remains limited by insufficient sensitivity to subtle lesions, whose visual evidence is often sparse, low-contrast, and embedded within complex anatomical context. As local visual tokens are aggregated, these weak lesion cues can become underrepresented in global image representations, making them difficult for medical VLMs to recognize. Existing efforts to improve lesion sensitivity mainly rely on medical-domain vision-encoder pre-training, clinical-term-guided alignment, or trainable pathological representation enhancement. Although effective, these approaches usually require additional training or model-specific adaptation and may overfit to particular disease morphologies, limiting their applicability to frozen medical VLMs. To address these limitations, we propose EasyLens, a training-free plug-and-play subtle-lesion representation amplifier for medical VLMs. EasyLens first constructs EasyBank, a pathology-anatomy prototype space that provides lesion-related prototypes and anatomy-aware normal references for comparing suspicious patches against both pathological and normal anatomical patterns. To avoid blindly amplifying normal tissues, EasyTag selects lesion-relevant patches through counterfactual prototype reasoning. To counteract the dilution of subtle lesion cues in global image representations, EasyAmplifier strengthens the selected lesion-relevant patch representations through morphology-guided residual enhancement, thereby increasing their contribution to the global image embedding. Experiments on multiple medical image datasets and frozen medical VLM backbones show that EasyLens improves subtle-lesion detection and outperforms existing encoder-enhancement baselines.

Artificial intelligence-assisted imaging analysis has made substantial strides in tumor diagnosis and management. Here we present PASTA, a pan-tumor CT foundation model that achieves state-of-the-art performance on 45 of 46 representative oncology tasks -- including lesion segmentation, tumor detection in plain CT, tumor staging, survival prediction, structured report generation, and cross-modality transfer learning, significantly outperforming the second-best models on 35 tasks. This remarkable advancement is driven by our development of PASTA-Gen, an innovative synthetic tumor generation framework that produces a comprehensive dataset of 30,000 CT scans with pixel-level annotated lesions and paired structured reports, encompassing malignancies across ten organs and five benign lesion types. By leveraging this rich, high-quality synthetic data, we overcome a longstanding bottleneck in the development of CT foundation models -- specifically, the scarcity of publicly available, high-quality annotated datasets due to privacy constraints and the substantial labor required for scaling precise data annotation. Encouragingly, PASTA demonstrates exceptional data efficiency with promising practical value, markedly improving performance on various tasks with only a small amount of real-world data. The open release of both the synthetic dataset and PASTA foundation model effectively addresses the challenge of data scarcity, thereby advancing oncological research and clinical translation.

The complexity and variability inherent in high-resolution pathological images present significant challenges in computational pathology. While pathology foundation models leveraging AI have catalyzed transformative advancements, their development demands large-scale datasets, considerable storage capacity, and substantial computational resources. Furthermore, ensuring their clinical applicability and generalizability requires rigorous validation across a broad spectrum of clinical tasks. Here, we present PathOrchestra, a versatile pathology foundation model trained via self-supervised learning on a dataset comprising 300K pathological slides from 20 tissue and organ types across multiple centers. The model was rigorously evaluated on 112 clinical tasks using a combination of 61 private and 51 public datasets. These tasks encompass digital slide preprocessing, pan-cancer classification, lesion identification, multi-cancer subtype classification, biomarker assessment, gene expression prediction, and the generation of structured reports. PathOrchestra demonstrated exceptional performance across 27,755 WSIs and 9,415,729 ROIs, achieving over 0.950 accuracy in 47 tasks, including pan-cancer classification across various organs, lymphoma subtype diagnosis, and bladder cancer screening. Notably, it is the first model to generate structured reports for high-incidence colorectal cancer and diagnostically complex lymphoma-areas that are infrequently addressed by foundational models but hold immense clinical potential. Overall, PathOrchestra exemplifies the feasibility and efficacy of a large-scale, self-supervised pathology foundation model, validated across a broad range of clinical-grade tasks. Its high accuracy and reduced reliance on extensive data annotation underline its potential for clinical integration, offering a pathway toward more efficient and high-quality medical services.

Vision-language models (VLMs) read an image and produce text in a single forward pass, whereas radiologists typically inspect an image several times and consult the literature before writing a report. We introduce GAZE (Grounded Agentic Zero-shot Evaluation), a framework that lets a medical VLM work in this iterative way by calling viewer-level tools (zoom, windowing, contrast, edge detection) and two retrieval tools backed by the U.S. National Library of Medicine (PubMed for medical literature, Open-i for radiological images), with structured outputs validated against a schema and full tool-call traces recorded for auditability. On NOVA, a benchmark of 906 brain MRI cases covering 281 rare neurological conditions, GAZE reaches 58.2 mean average precision (mAP) at intersection-over-union (IoU) 0.3 for lesion localisation and 34.9% Top-1 diagnostic accuracy under a joint protocol that scores captioning, diagnosis, and localisation from the image alone, without task-specific fine-tuning. Before any tool is used, structured prompting and schema-validated outputs already improve over the published Gemini 2.0 Flash baseline (20.2 to 29.4 mAP@0.3), so framework design is itself an experimental variable. Tool use helps rare pathologies disproportionately: the fraction of cases with IoU > 0.3 rises from 17% to 58% for diagnoses with three or fewer examples versus 25% to 68% for common conditions (geq10 cases), with gains tracking engagement (Gemini 3 Flash: Cohen's d = 0.79, 11.8 tool calls per case; Gemini 2.0 Flash: tools used in 8.2% of cases, no significant benefit). Retrieval ablations additionally reveal a model-dependent trade-off in which gains in diagnosis can coincide with losses in localisation, reinforcing the case for joint evaluation of diagnosis, localisation, and captioning in medical VLMs.

Objective: Although medical imaging datasets are increasingly available, abnormal and annotation-intensive findings critical to lung cancer screening, particularly small pulmonary nodules, remain underrepresented and inconsistently curated. Methods: We introduce NodMAISI, an anatomically constrained, nodule-oriented CT synthesis and augmentation framework trained on a unified multi-source cohort (7,042 patients, 8,841 CTs, 14,444 nodules). The framework integrates: (i) a standardized curation and annotation pipeline linking each CT with organ masks and nodule-level annotations, (ii) a ControlNet-conditioned rectified-flow generator built on MAISI-v2's foundational blocks to enforce anatomy- and lesion-consistent synthesis, and (iii) lesion-aware augmentation that perturbs nodule masks (controlled shrinkage) while preserving surrounding anatomy to generate paired CT variants. Results: Across six public test datasets, NodMAISI improved distributional fidelity relative to MAISI-v2 (real-to-synthetic FID range 1.18 to 2.99 vs 1.69 to 5.21). In lesion detectability analysis using a MONAI nodule detector, NodMAISI substantially increased average sensitivity and more closely matched clinical scans (IMD-CT: 0.69 vs 0.39; DLCS24: 0.63 vs 0.20), with the largest gains for sub-centimeter nodules where MAISI-v2 frequently failed to reproduce the conditioned lesion. In downstream nodule-level malignancy classification trained on LUNA25 and externally evaluated on LUNA16, LNDbv4, and DLCS24, NodMAISI augmentation improved AUC by 0.07 to 0.11 at <=20% clinical data and by 0.12 to 0.21 at 10%, consistently narrowing the performance gap under data scarcity.

Large language models (LLMs) have recently demonstrated their potential in clinical applications, providing valuable medical knowledge and advice. For example, a large dialog LLM like ChatGPT has successfully passed part of the US medical licensing exam. However, LLMs currently have difficulty processing images, making it challenging to interpret information from medical images, which are rich in information that supports clinical decisions. On the other hand, computer-aided diagnosis (CAD) networks for medical images have seen significant success in the medical field by using advanced deep-learning algorithms to support clinical decision-making. This paper presents a method for integrating LLMs into medical-image CAD networks. The proposed framework uses LLMs to enhance the output of multiple CAD networks, such as diagnosis networks, lesion segmentation networks, and report generation networks, by summarizing and reorganizing the information presented in natural language text format. The goal is to merge the strengths of LLMs' medical domain knowledge and logical reasoning with the vision understanding capability of existing medical-image CAD models to create a more user-friendly and understandable system for patients compared to conventional CAD systems. In the future, LLM's medical knowledge can be also used to improve the performance of vision-based medical-image CAD models.

Medical imaging provides critical evidence for clinical diagnosis, treatment planning, and surgical decisions, yet most existing imaging models are narrowly focused and require multiple specialized networks, limiting their generalization. Although large-scale language and multimodal models exhibit strong reasoning and multi-task capabilities, real-world clinical applications demand precise visual grounding, multimodal integration, and chain-of-thought reasoning. We introduce Citrus-V, a multimodal medical foundation model that combines image analysis with textual reasoning. The model integrates detection, segmentation, and multimodal chain-of-thought reasoning, enabling pixel-level lesion localization, structured report generation, and physician-like diagnostic inference in a single framework. We propose a novel multimodal training approach and release a curated open-source data suite covering reasoning, detection, segmentation, and document understanding tasks. Evaluations demonstrate that Citrus-V outperforms existing open-source medical models and expert-level imaging systems across multiple benchmarks, delivering a unified pipeline from visual grounding to clinical reasoning and supporting precise lesion quantification, automated reporting, and reliable second opinions.

Autonomous agents are increasingly expected to support end-to-end medical-AI research workflows, moving beyond isolated prediction tasks or short-form clinical question answering. However, existing medical agent benchmarks primarily evaluate final outputs, providing limited visibility into agent behavior within the research process. To address this gap, we present AutoMedBench, a workflow-aware benchmark for autonomous medical-AI research across diverse medical imaging and multimodal inference tasks, organizing agent execution into a unified five-stage workflow (S1-S5): Plan, Setup, Validate, Inference, and Submit. It comprises long-horizon tasks with each run averaging 33 agent turns, spanning five research tracks: segmentation, image enhancement, visual question answering (VQA), report generation, and lesion detection. Each task is evaluated under two difficulty tiers, Lite and Standard, which use the same data and metrics but differ in the amount of task-brief scaffolding, and each run is scored using both final task performance and S1-S5 stage scores, enabling stage-level analysis from the initial task brief to the final submitted artifact. Across thousands of recorded runs, stage-level scoring reveals that Validate is the weakest workflow stage on average, whereas Setup is the strongest, suggesting that current agents are better at making pipelines executable than at verifying their reliability. Post-run error analysis further shows that verification and submission failures dominate tagged errors, accounting for 37.7% and 38.1% of fired codes respectively, whereas task-understanding errors are rare at 0.9%, and runs with one fired error code have a 48% lower overall score than runs with no error code on average.

Artificial intelligence (AI) that can effectively learn ultrasound representations by integrating multi-source data holds significant promise for advancing clinical care. However, the scarcity of large labeled datasets in real-world clinical environments and the limited generalizability of task-specific models have hindered the development of generalizable clinical AI models for ultrasound applications. In this study, we present EchoCare, a novel ultrasound foundation model for generalist clinical use, developed via self-supervised learning on our curated, publicly available, large-scale dataset EchoCareData. EchoCareData comprises 4.5 million ultrasound images, sourced from over 23 countries across 5 continents and acquired via a diverse range of distinct imaging devices, thus encompassing global cohorts that are multi-center, multi-device, and multi-ethnic. Unlike prior studies that adopt off-the-shelf vision foundation model architectures, we introduce a hierarchical classifier into EchoCare to enable joint learning of pixel-level and representation-level features, capturing both global anatomical contexts and local ultrasound characteristics. With minimal training, EchoCare outperforms state-of-the-art comparison models across 10 representative ultrasound benchmarks of varying diagnostic difficulties, spanning disease diagnosis, lesion segmentation, organ detection, landmark prediction, quantitative regression, imaging enhancement and report generation. The code and pretrained model are publicly released, rendering EchoCare accessible for fine-tuning and local adaptation, supporting extensibility to additional applications. EchoCare provides a fully open and generalizable foundation model to boost the development of AI technologies for diverse clinical ultrasound applications.

Large Language Model (LLM) based AI educational content generation systems are increasingly being developed, yet no standardised benchmark exists to systematically evaluate them. This study introduces LessonBench-V1, a benchmark dataset comprising 647 human-written lessons paired with LLM-based reverse-engineered lesson plans across 240 STEM topics spanning mathematics, physics, chemistry, and computer science. The lessons are drawn from 97 trusted open sources, including LibreTexts, Brilliant.org and GeeksForGeeks. Each lesson plan is human-reviewed and produced through a pedagogically grounded methodology that synthesises Bloom's Taxonomy, Gagné's Events, Merrill's First Principles, and the 5E Instructional Model. The lesson plans capture 3,620 learning objectives with pedagogical metadata, enabling systematic, reproducible evaluation of lesson-generation AI agents and supporting further research. The study further proposes a three-dimensional evaluation pipeline for use with the dataset.

Content generation modeling has emerged as a promising direction in computational pathology, offering capabilities such as data-efficient learning, synthetic data augmentation, and task-oriented generation across diverse diagnostic tasks. This review provides a comprehensive synthesis of recent progress in the field, organized into four key domains: image generation, text generation, molecular profile-morphology generation, and other specialized generation applications. By analyzing over 150 representative studies, we trace the evolution of content generation architectures -- from early generative adversarial networks to recent advances in diffusion models and generative vision-language models. We further examine the datasets and evaluation protocols commonly used in this domain and highlight ongoing limitations, including challenges in generating high-fidelity whole slide images, clinical interpretability, and concerns related to the ethical and legal implications of synthetic data. The review concludes with a discussion of open challenges and prospective research directions, with an emphasis on developing integrated and clinically deployable generation systems. This work aims to provide a foundational reference for researchers and practitioners developing content generation models in computational pathology.

In this work, we present LesionLocator, a framework for zero-shot longitudinal lesion tracking and segmentation in 3D medical imaging, establishing the first end-to-end model capable of 4D tracking with dense spatial prompts. Our model leverages an extensive dataset of 23,262 annotated medical scans, as well as synthesized longitudinal data across diverse lesion types. The diversity and scale of our dataset significantly enhances model generalizability to real-world medical imaging challenges and addresses key limitations in longitudinal data availability. LesionLocator outperforms all existing promptable models in lesion segmentation by nearly 10 dice points, reaching human-level performance, and achieves state-of-the-art results in lesion tracking, with superior lesion retrieval and segmentation accuracy. LesionLocator not only sets a new benchmark in universal promptable lesion segmentation and automated longitudinal lesion tracking but also provides the first open-access solution of its kind, releasing our synthetic 4D dataset and model to the community, empowering future advancements in medical imaging. Code is available at: www.github.com/MIC-DKFZ/LesionLocator

We explore the automatic generation of interactive, scenario-based lessons designed to train novice human tutors who teach middle school mathematics online. Employing prompt engineering through a Retrieval-Augmented Generation approach with GPT-4o, we developed a system capable of creating structured tutor training lessons. Our study generated lessons in English for three key topics: Encouraging Students' Independence, Encouraging Help-Seeking Behavior, and Turning on Cameras, using a task decomposition prompting strategy that breaks lesson generation into sub-tasks. The generated lessons were evaluated by two human evaluators, who provided both quantitative and qualitative evaluations using a comprehensive rubric informed by lesson design research. Results demonstrate that the task decomposition strategy led to higher-rated lessons compared to single-step generation. Human evaluators identified several strengths in the LLM-generated lessons, including well-structured content and time-saving potential, while also noting limitations such as generic feedback and a lack of clarity in some instructional sections. These findings underscore the potential of hybrid human-AI approaches for generating effective lessons in tutor training.

While hundreds of artificial intelligence (AI) algorithms are now approved or cleared by the US Food and Drugs Administration (FDA), many studies have shown inconsistent generalization or latent bias, particularly for underrepresented populations. Some have proposed that generative AI could reduce the need for real data, but its utility in model development remains unclear. Skin disease serves as a useful case study in synthetic image generation due to the diversity of disease appearance, particularly across the protected attribute of skin tone. Here we show that latent diffusion models can scalably generate images of skin disease and that augmenting model training with these data improves performance in data-limited settings. These performance gains saturate at synthetic-to-real image ratios above 10:1 and are substantially smaller than the gains obtained from adding real images. As part of our analysis, we generate and analyze a new dataset of 458,920 synthetic images produced using several generation strategies. Our results suggest that synthetic data could serve as a force-multiplier for model development, but the collection of diverse real-world data remains the most important step to improve medical AI algorithms.

Generative modeling has experienced substantial progress in recent years, particularly in text-to-image and text-to-video synthesis. However, the medical field has not yet fully exploited the potential of large-scale foundational models for synthetic data generation. In this paper, we introduce GenerateCT, the first method for text-conditional computed tomography (CT) generation, addressing the limitations in 3D medical imaging research and making our entire framework open-source. GenerateCT consists of a pre-trained large language model, a transformer-based text-conditional 3D chest CT generation architecture, and a text-conditional spatial super-resolution diffusion model. We also propose CT-ViT, which efficiently compresses CT volumes while preserving auto-regressiveness in-depth, enabling the generation of 3D CT volumes with variable numbers of axial slices. Our experiments demonstrate that GenerateCT can produce realistic, high-resolution, and high-fidelity 3D chest CT volumes consistent with medical language text prompts. We further investigate the potential of GenerateCT by training a model using generated CT volumes for multi-abnormality classification of chest CT volumes. Our contributions provide a valuable foundation for future research in text-conditional 3D medical image generation and have the potential to accelerate advancements in medical imaging research. Our code, pre-trained models, and generated data are available at https://github.com/ibrahimethemhamamci/GenerateCT.

This paper introduces an innovative methodology for producing high-quality 3D lung CT images guided by textual information. While diffusion-based generative models are increasingly used in medical imaging, current state-of-the-art approaches are limited to low-resolution outputs and underutilize radiology reports' abundant information. The radiology reports can enhance the generation process by providing additional guidance and offering fine-grained control over the synthesis of images. Nevertheless, expanding text-guided generation to high-resolution 3D images poses significant memory and anatomical detail-preserving challenges. Addressing the memory issue, we introduce a hierarchical scheme that uses a modified UNet architecture. We start by synthesizing low-resolution images conditioned on the text, serving as a foundation for subsequent generators for complete volumetric data. To ensure the anatomical plausibility of the generated samples, we provide further guidance by generating vascular, airway, and lobular segmentation masks in conjunction with the CT images. The model demonstrates the capability to use textual input and segmentation tasks to generate synthesized images. The results of comparative assessments indicate that our approach exhibits superior performance compared to the most advanced models based on GAN and diffusion techniques, especially in accurately retaining crucial anatomical features such as fissure lines, airways, and vascular structures. This innovation introduces novel possibilities. This study focuses on two main objectives: (1) the development of a method for creating images based on textual prompts and anatomical components, and (2) the capability to generate new images conditioning on anatomical elements. The advancements in image generation can be applied to enhance numerous downstream tasks.

Skin lesion datasets consist predominantly of normal samples with only a small percentage of abnormal ones, giving rise to the class imbalance problem. Also, skin lesion images are largely similar in overall appearance owing to the low inter-class variability. In this paper, we propose a two-stage framework for automatic classification of skin lesion images using adversarial training and transfer learning toward melanoma detection. In the first stage, we leverage the inter-class variation of the data distribution for the task of conditional image synthesis by learning the inter-class mapping and synthesizing under-represented class samples from the over-represented ones using unpaired image-to-image translation. In the second stage, we train a deep convolutional neural network for skin lesion classification using the original training set combined with the newly synthesized under-represented class samples. The training of this classifier is carried out by minimizing the focal loss function, which assists the model in learning from hard examples, while down-weighting the easy ones. Experiments conducted on a dermatology image benchmark demonstrate the superiority of our proposed approach over several standard baseline methods, achieving significant performance improvements. Interestingly, we show through feature visualization and analysis that our method leads to context based lesion assessment that can reach an expert dermatologist level.

The traditional image inpainting task aims to restore corrupted regions by referencing surrounding background and foreground. However, the object erasure task, which is in increasing demand, aims to erase objects and generate harmonious background. Previous GAN-based inpainting methods struggle with intricate texture generation. Emerging diffusion model-based algorithms, such as Stable Diffusion Inpainting, exhibit the capability to generate novel content, but they often produce incongruent results at the locations of the erased objects and require high-quality text prompt inputs. To address these challenges, we introduce MagicEraser, a diffusion model-based framework tailored for the object erasure task. It consists of two phases: content initialization and controllable generation. In the latter phase, we develop two plug-and-play modules called prompt tuning and semantics-aware attention refocus. Additionally, we propose a data construction strategy that generates training data specially suitable for this task. MagicEraser achieves fine and effective control of content generation while mitigating undesired artifacts. Experimental results highlight a valuable advancement of our approach in the object erasure task.

Diffusion transformers (DiTs) equipped with multimodal attention (MM-Attn) have become a dominant paradigm for image generation. However, preventing the generation of harmful content remains a critical challenge, particularly in image-to-image (I2I) editing tasks. Existing safety mechanisms are primarily designed for text-to-image (T2I) synthesis or U-Net-based architectures, which limits their effectiveness for unified safety mitigation in DiT-based frameworks. To bridge this gap, we propose Unified Visual Safety Regulator (UVR), a training-free safe generation framework that regulates unsafe semantics in generated images. UVR is grounded in an analysis of attention dynamics from the perspective of information flow in MM-Attn. We identify a task-independent start-up stage, during which unsafe semantics in output patches rapidly emerge and can be accurately localized, followed by task-specific semantic amplification and interference stages, where harmful signals are further propagated and entangled with benign content. Based on these observations, UVR mitigates unsafe generation through unified, targeted attention modulation and explicit restriction of harmful information flow over the identified unsafe output patches. Experiments across various concepts show that UVR achieves state-of-the-art safety performance by achieving 91% and 77% erase rate in image synthesis and editing tasks, while preserving visual quality and fidelity with minimal degradation. Code is available at https://github.com/deng12yx/UVR.

The applicability of current lesion segmentation models for chest X-rays (CXRs) has been limited both by a small number of target labels and the reliance on long, detailed expert-level text inputs, creating a barrier to practical use. To address these limitations, we introduce a new paradigm: instruction-guided lesion segmentation (ILS), which is designed to segment diverse lesion types based on simple, user-friendly instructions. Under this paradigm, we construct MIMIC-ILS, the first large-scale instruction-answer dataset for CXR lesion segmentation, using our fully automated multimodal pipeline that generates annotations from chest X-ray images and their corresponding reports. MIMIC-ILS contains 1.1M instruction-answer pairs derived from 192K images and 91K unique segmentation masks, covering seven major lesion types. To empirically demonstrate its utility, we introduce ROSALIA, a vision-language model fine-tuned on MIMIC-ILS. ROSALIA can segment diverse lesions and provide textual explanations in response to user instructions. The model achieves high segmentation and textual accuracy in our newly proposed task, highlighting the effectiveness of our pipeline and the value of MIMIC-ILS as a foundational resource for pixel-level CXR lesion grounding.

Text-to-image models are powerful tools for image creation. However, the generation process is akin to a dice roll and makes it difficult to achieve a single image that captures everything a user wants. In this paper, we propose a framework for creating the desired image by compositing it from various parts of generated images, in essence forming a Generative Photomontage. Given a stack of images generated by ControlNet using the same input condition and different seeds, we let users select desired parts from the generated results using a brush stroke interface. We introduce a novel technique that takes in the user's brush strokes, segments the generated images using a graph-based optimization in diffusion feature space, and then composites the segmented regions via a new feature-space blending method. Our method faithfully preserves the user-selected regions while compositing them harmoniously. We demonstrate that our flexible framework can be used for many applications, including generating new appearance combinations, fixing incorrect shapes and artifacts, and improving prompt alignment. We show compelling results for each application and demonstrate that our method outperforms existing image blending methods and various baselines.

Accurate lesion segmentation is essential in medical image analysis, yet most existing methods are designed for specific anatomical sites or imaging modalities, limiting their generalizability. Recent vision-language foundation models enable concept-driven segmentation in natural images, offering a promising direction for more flexible medical image analysis. However, concept-prompt-based lesion segmentation, particularly with the latest Segment Anything Model 3 (SAM3), remains underexplored. In this work, we present a systematic evaluation of SAM3 for lesion segmentation. We assess its performance using geometric bounding boxes and concept-based text and image prompts across multiple modalities, including multiparametric MRI, CT, ultrasound, dermoscopy, and endoscopy. To improve robustness, we incorporate additional prior knowledge, such as adjacent-slice predictions, multiparametric information, and prior annotations. We further compare different fine-tuning strategies, including partial module tuning, adapter-based methods, and full-model optimization. Experiments on 13 datasets covering 11 lesion types demonstrate that SAM3 achieves strong cross-modality generalization, reliable concept-driven segmentation, and accurate lesion delineation. These results highlight the potential of concept-based foundation models for scalable and practical medical image segmentation. Code and trained models will be released at: https://github.com/apple1986/lesion-sam3

Current 3D/4D generation methods are usually optimized for photorealism, efficiency, and aesthetics. However, they often fail to preserve the semantic identity of the subject across different viewpoints. Adapting generation methods with one or few images of a specific subject (also known as Personalization or Subject-driven generation) allows generating visual content that align with the identity of the subject. However, personalized 3D/4D generation is still largely underexplored. In this work, we introduce TIRE (Track, Inpaint, REsplat), a novel method for subject-driven 3D/4D generation. It takes an initial 3D asset produced by an existing 3D generative model as input and uses video tracking to identify the regions that need to be modified. Then, we adopt a subject-driven 2D inpainting model for progressively infilling the identified regions. Finally, we resplat the modified 2D multi-view observations back to 3D while still maintaining consistency. Extensive experiments demonstrate that our approach significantly improves identity preservation in 3D/4D generation compared to state-of-the-art methods. Our project website is available at https://zsh2000.github.io/track-inpaint-resplat.github.io/.

We present a new method for multimodal conditional 3D face geometry generation that allows user-friendly control over the output identity and expression via a number of different conditioning signals. Within a single model, we demonstrate 3D faces generated from artistic sketches, portrait photos, Canny edges, FLAME face model parameters, 2D face landmarks, or text prompts. Our approach is based on a diffusion process that generates 3D geometry in a 2D parameterized UV domain. Geometry generation passes each conditioning signal through a set of cross-attention layers (IP-Adapter), one set for each user-defined conditioning signal. The result is an easy-to-use 3D face generation tool that produces topology-consistent, high-quality geometry with fine-grain user control.

Diffusion models have revolutionized image generation, yet several challenges restrict their application to large-image domains, such as digital pathology and satellite imagery. Given that it is infeasible to directly train a model on 'whole' images from domains with potential gigapixel sizes, diffusion-based generative methods have focused on synthesizing small, fixed-size patches extracted from these images. However, generating small patches has limited applicability since patch-based models fail to capture the global structures and wider context of large images, which can be crucial for synthesizing (semantically) accurate samples. To overcome this limitation, we present ZoomLDM, a diffusion model tailored for generating images across multiple scales. Central to our approach is a novel magnification-aware conditioning mechanism that utilizes self-supervised learning (SSL) embeddings and allows the diffusion model to synthesize images at different 'zoom' levels, i.e., fixed-size patches extracted from large images at varying scales. ZoomLDM synthesizes coherent histopathology images that remain contextually accurate and detailed at different zoom levels, achieving state-of-the-art image generation quality across all scales and excelling in the data-scarce setting of generating thumbnails of entire large images. The multi-scale nature of ZoomLDM unlocks additional capabilities in large image generation, enabling computationally tractable and globally coherent image synthesis up to 4096 times 4096 pixels and 4times super-resolution. Additionally, multi-scale features extracted from ZoomLDM are highly effective in multiple instance learning experiments.

Given a small number of images of a subject, personalized image generation techniques can fine-tune large pre-trained text-to-image diffusion models to generate images of the subject in novel contexts, conditioned on text prompts. In doing so, a trade-off is made between prompt fidelity, subject fidelity and diversity. As the pre-trained model is fine-tuned, earlier checkpoints synthesize images with low subject fidelity but high prompt fidelity and diversity. In contrast, later checkpoints generate images with low prompt fidelity and diversity but high subject fidelity. This inherent trade-off limits the prompt fidelity, subject fidelity and diversity of generated images. In this work, we propose DreamBlend to combine the prompt fidelity from earlier checkpoints and the subject fidelity from later checkpoints during inference. We perform a cross attention guided image synthesis from a later checkpoint, guided by an image generated by an earlier checkpoint, for the same prompt. This enables generation of images with better subject fidelity, prompt fidelity and diversity on challenging prompts, outperforming state-of-the-art fine-tuning methods.

Deep learning models have emerged as a powerful tool for various medical applications. However, their success depends on large, high-quality datasets that are challenging to obtain due to privacy concerns and costly annotation. Generative models, such as diffusion models, offer a potential solution by synthesizing medical images, but their practical adoption is hindered by long inference times. In this paper, we propose the use of an optimal transport flow matching approach to accelerate image generation. By introducing a straighter mapping between the source and target distribution, our method significantly reduces inference time while preserving and further enhancing the quality of the outputs. Furthermore, this approach is highly adaptable, supporting various medical imaging modalities, conditioning mechanisms (such as class labels and masks), and different spatial dimensions, including 2D and 3D. Beyond image generation, it can also be applied to related tasks such as image enhancement. Our results demonstrate the efficiency and versatility of this framework, making it a promising advancement for medical imaging applications. Code with checkpoints and a synthetic dataset (beneficial for classification and segmentation) is now available on: https://github.com/milad1378yz/MOTFM.

The rapid increase of computed tomography (CT) scans and their time-consuming manual analysis have created an urgent need for robust automated analysis techniques in clinical settings. These aim to assist radiologists and help them managing their growing workload. Existing methods typically generate entire reports directly from 3D CT images, without explicitly focusing on observed abnormalities. This unguided approach often results in repetitive content or incomplete reports, failing to prioritize anomaly-specific descriptions. We propose a new anomaly-guided report generation model, which first predicts abnormalities and then generates targeted descriptions for each. Evaluation on a public dataset demonstrates significant improvements in report quality and clinical relevance. We extend our work by conducting an ablation study to demonstrate its effectiveness.

Dermatological practice routinely involves measuring and tracking lesion size, morphology and texture, as critical components of wound or skin cancer screening, monitoring and diagnosis. To accomplish this task, practitioners often image the skin surface with commonly available off-the-shelf camera sensors. This has led to an overwhelming research focus on 2D methods while these objectives naturally benefit from 3D information. In this paper, we demonstrate that dense monocular 3D reconstructions, metric scale measurements and rich surface normal texture estimates are achievable for both dermoscopic and macroscopic cases without the need for additional hardware or multiple captures. We present DermDepth, the first single-view metric scale 3D model for the dermatological domain and D-Synth, the first synthetic dermoscopic dataset with pixel-perfect 3D information. Our experiments show training DermDepth on D-Synth corrects metric scale error from over 16x to under 1.1x for real dermoscopic data, while preserving geometric quality and increasing texture richness. Fine-tuning on a small amount of real clinical samples generalizes our method across three real-world benchmarks spanning the few mm to hundred cm range, diverse skin-tones, chronic wound cases and produces measurements broadly consistent with disease size reported in medical literature. All code, data and models are available at https://github.com/hectorcarrion/dermdepth.

Painting embodies a unique form of visual storytelling, where the creation process is as significant as the final artwork. Although recent advances in generative models have enabled visually compelling painting synthesis, most existing methods focus solely on final image generation or patch-based process simulation, lacking explicit stroke structure and failing to produce smooth, realistic shading. In this work, we present a differentiable stroke reconstruction framework that unifies painting, stylized texturing, and smudging to faithfully reproduce the human painting-smudging loop. Given an input image, our framework first optimizes single- and dual-color Bezier strokes through a parallel differentiable paint renderer, followed by a style generation module that synthesizes geometry-conditioned textures across diverse painting styles. We further introduce a differentiable smudge operator to enable natural color blending and shading. Coupled with a coarse-to-fine optimization strategy, our method jointly optimizes stroke geometry, color, and texture under geometric and semantic guidance. Extensive experiments on oil, watercolor, ink, and digital paintings demonstrate that our approach produces realistic and expressive stroke reconstructions, smooth tonal transitions, and richly stylized appearances, offering a unified model for expressive digital painting creation. See our project page for more demos: https://yingjiang96.github.io/DiffPaintWebsite/.

Size measurements of tumor manifestations on follow-up CT examinations are crucial for evaluating treatment outcomes in cancer patients. Efficient lesion segmentation can speed up these radiological workflows. While numerous benchmarks and challenges address lesion segmentation in specific organs like the liver, kidneys, and lungs, the larger variety of lesion types encountered in clinical practice demands a more universal approach. To address this gap, we introduced the ULS23 benchmark for 3D universal lesion segmentation in chest-abdomen-pelvis CT examinations. The ULS23 training dataset contains 38,693 lesions across this region, including challenging pancreatic, colon and bone lesions. For evaluation purposes, we curated a dataset comprising 775 lesions from 284 patients. Each of these lesions was identified as a target lesion in a clinical context, ensuring diversity and clinical relevance within this dataset. The ULS23 benchmark is publicly accessible via uls23.grand-challenge.org, enabling researchers worldwide to assess the performance of their segmentation methods. Furthermore, we have developed and publicly released our baseline semi-supervised 3D lesion segmentation model. This model achieved an average Dice coefficient of 0.703 pm 0.240 on the challenge test set. We invite ongoing submissions to advance the development of future ULS models.

For several skin conditions such as vitiligo, accurate segmentation of lesions from skin images is the primary measure of disease progression and severity. Existing methods for vitiligo lesion segmentation require manual intervention. Unfortunately, manual segmentation is time and labor-intensive, as well as irreproducible between physicians. We introduce a convolutional neural network (CNN) that quickly and robustly performs vitiligo skin lesion segmentation. Our CNN has a U-Net architecture with a modified contracting path. We use the CNN to generate an initial segmentation of the lesion, then refine it by running the watershed algorithm on high-confidence pixels. We train the network on 247 images with a variety of lesion sizes, complexity, and anatomical sites. The network with our modifications noticeably outperforms the state-of-the-art U-Net, with a Jaccard Index (JI) score of 73.6% (compared to 36.7%). Moreover, our method requires only a few seconds for segmentation, in contrast with the previously proposed semi-autonomous watershed approach, which requires 2-29 minutes per image.

Recent text-to-image generative models have demonstrated an unparalleled ability to generate diverse and creative imagery guided by a target text prompt. While revolutionary, current state-of-the-art diffusion models may still fail in generating images that fully convey the semantics in the given text prompt. We analyze the publicly available Stable Diffusion model and assess the existence of catastrophic neglect, where the model fails to generate one or more of the subjects from the input prompt. Moreover, we find that in some cases the model also fails to correctly bind attributes (e.g., colors) to their corresponding subjects. To help mitigate these failure cases, we introduce the concept of Generative Semantic Nursing (GSN), where we seek to intervene in the generative process on the fly during inference time to improve the faithfulness of the generated images. Using an attention-based formulation of GSN, dubbed Attend-and-Excite, we guide the model to refine the cross-attention units to attend to all subject tokens in the text prompt and strengthen - or excite - their activations, encouraging the model to generate all subjects described in the text prompt. We compare our approach to alternative approaches and demonstrate that it conveys the desired concepts more faithfully across a range of text prompts.

Deep learning-based image generation has seen significant advancements with diffusion models, notably improving the quality of generated images. Despite these developments, generating images with unseen characteristics beneficial for downstream tasks has received limited attention. To bridge this gap, we propose Style-Extracting Diffusion Models, featuring two conditioning mechanisms. Specifically, we utilize 1) a style conditioning mechanism which allows to inject style information of previously unseen images during image generation and 2) a content conditioning which can be targeted to a downstream task, e.g., layout for segmentation. We introduce a trainable style encoder to extract style information from images, and an aggregation block that merges style information from multiple style inputs. This architecture enables the generation of images with unseen styles in a zero-shot manner, by leveraging styles from unseen images, resulting in more diverse generations. In this work, we use the image layout as target condition and first show the capability of our method on a natural image dataset as a proof-of-concept. We further demonstrate its versatility in histopathology, where we combine prior knowledge about tissue composition and unannotated data to create diverse synthetic images with known layouts. This allows us to generate additional synthetic data to train a segmentation network in a semi-supervised fashion. We verify the added value of the generated images by showing improved segmentation results and lower performance variability between patients when synthetic images are included during segmentation training. Our code will be made publicly available at [LINK].

During their formative years, radiology trainees are required to interpret hundreds of mammograms per month, with the objective of becoming apt at discerning the subtle patterns differentiating benign from malignant lesions. Unfortunately, medico-legal and technical hurdles make it difficult to access and query medical images for training. In this paper we train a generative adversarial network (GAN) to synthesize 512 x 512 high-resolution mammograms. The resulting model leads to the unsupervised separation of high-level features (e.g. the standard mammography views and the nature of the breast lesions), with stochastic variation in the generated images (e.g. breast adipose tissue, calcification), enabling user-controlled global and local attribute-editing of the synthesized images. We demonstrate the model's ability to generate anatomically and medically relevant mammograms by achieving an average AUC of 0.54 in a double-blind study on four expert mammography radiologists to distinguish between generated and real images, ascribing to the high visual quality of the synthesized and edited mammograms, and to their potential use in advancing and facilitating medical education.

Recently, diffusion models have emerged as promising newcomers in the field of generative models, shining brightly in image generation. However, when employed for object removal tasks, they still encounter issues such as generating random artifacts and the incapacity to repaint foreground object areas with appropriate content after removal. To tackle these problems, we propose Attentive Eraser, a tuning-free method to empower pre-trained diffusion models for stable and effective object removal. Firstly, in light of the observation that the self-attention maps influence the structure and shape details of the generated images, we propose Attention Activation and Suppression (ASS), which re-engineers the self-attention mechanism within the pre-trained diffusion models based on the given mask, thereby prioritizing the background over the foreground object during the reverse generation process. Moreover, we introduce Self-Attention Redirection Guidance (SARG), which utilizes the self-attention redirected by ASS to guide the generation process, effectively removing foreground objects within the mask while simultaneously generating content that is both plausible and coherent. Experiments demonstrate the stability and effectiveness of Attentive Eraser in object removal across a variety of pre-trained diffusion models, outperforming even training-based methods. Furthermore, Attentive Eraser can be implemented in various diffusion model architectures and checkpoints, enabling excellent scalability. Code is available at https://github.com/Anonym0u3/AttentiveEraser.

Disease progression simulation is a crucial area of research that has significant implications for clinical diagnosis, prognosis, and treatment. One major challenge in this field is the lack of continuous medical imaging monitoring of individual patients over time. To address this issue, we develop a novel framework termed Progressive Image Editing (PIE) that enables controlled manipulation of disease-related image features, facilitating precise and realistic disease progression simulation. Specifically, we leverage recent advancements in text-to-image generative models to simulate disease progression accurately and personalize it for each patient. We theoretically analyze the iterative refining process in our framework as a gradient descent with an exponentially decayed learning rate. To validate our framework, we conduct experiments in three medical imaging domains. Our results demonstrate the superiority of PIE over existing methods such as Stable Diffusion Walk and Style-Based Manifold Extrapolation based on CLIP score (Realism) and Disease Classification Confidence (Alignment). Our user study collected feedback from 35 veteran physicians to assess the generated progressions. Remarkably, 76.2% of the feedback agrees with the fidelity of the generated progressions. To our best knowledge, PIE is the first of its kind to generate disease progression images meeting real-world standards. It is a promising tool for medical research and clinical practice, potentially allowing healthcare providers to model disease trajectories over time, predict future treatment responses, and improve patient outcomes.

Acquiring and annotating sufficient labeled data is crucial in developing accurate and robust learning-based models, but obtaining such data can be challenging in many medical image segmentation tasks. One promising solution is to synthesize realistic data with ground-truth mask annotations. However, no prior studies have explored generating complete 3D volumetric images with masks. In this paper, we present MedGen3D, a deep generative framework that can generate paired 3D medical images and masks. First, we represent the 3D medical data as 2D sequences and propose the Multi-Condition Diffusion Probabilistic Model (MC-DPM) to generate multi-label mask sequences adhering to anatomical geometry. Then, we use an image sequence generator and semantic diffusion refiner conditioned on the generated mask sequences to produce realistic 3D medical images that align with the generated masks. Our proposed framework guarantees accurate alignment between synthetic images and segmentation maps. Experiments on 3D thoracic CT and brain MRI datasets show that our synthetic data is both diverse and faithful to the original data, and demonstrate the benefits for downstream segmentation tasks. We anticipate that MedGen3D's ability to synthesize paired 3D medical images and masks will prove valuable in training deep learning models for medical imaging tasks.

Recently, 3D generation methods have shown their powerful ability to automate 3D model creation. However, most 3D generation methods only rely on an input image or a text prompt to generate a 3D model, which lacks the control of each component of the generated 3D model. Any modifications of the input image lead to an entire regeneration of the 3D models. In this paper, we introduce a new method called CMD that generates a 3D model from an input image while enabling flexible local editing of each component of the 3D model. In CMD, we formulate the 3D generation as a conditional multiview diffusion model, which takes the existing or known parts as conditions and generates the edited or added components. This conditional multiview diffusion model not only allows the generation of 3D models part by part but also enables local editing of 3D models according to the local revision of the input image without changing other 3D parts. Extensive experiments are conducted to demonstrate that CMD decomposes a complex 3D generation task into multiple components, improving the generation quality. Meanwhile, CMD enables efficient and flexible local editing of a 3D model by just editing one rendered image.

In the rapidly advancing realm of visual generation, diffusion models have revolutionized the landscape, marking a significant shift in capabilities with their impressive text-guided generative functions. However, relying solely on text for conditioning these models does not fully cater to the varied and complex requirements of different applications and scenarios. Acknowledging this shortfall, a variety of studies aim to control pre-trained text-to-image (T2I) models to support novel conditions. In this survey, we undertake a thorough review of the literature on controllable generation with T2I diffusion models, covering both the theoretical foundations and practical advancements in this domain. Our review begins with a brief introduction to the basics of denoising diffusion probabilistic models (DDPMs) and widely used T2I diffusion models. We then reveal the controlling mechanisms of diffusion models, theoretically analyzing how novel conditions are introduced into the denoising process for conditional generation. Additionally, we offer a detailed overview of research in this area, organizing it into distinct categories from the condition perspective: generation with specific conditions, generation with multiple conditions, and universal controllable generation. For an exhaustive list of the controllable generation literature surveyed, please refer to our curated repository at https://github.com/PRIV-Creation/Awesome-Controllable-T2I-Diffusion-Models.

Text-to-image generative models have made remarkable advancements in generating high-quality images. However, generated images often contain undesirable artifacts or other errors due to model limitations. Existing techniques to fine-tune generated images are time-consuming (manual editing), produce poorly-integrated results (inpainting), or result in unexpected changes across the entire image (variation selection and prompt fine-tuning). In this work, we present Diffusion Brush, a Latent Diffusion Model-based (LDM) tool to efficiently fine-tune desired regions within an AI-synthesized image. Our method introduces new random noise patterns at targeted regions during the reverse diffusion process, enabling the model to efficiently make changes to the specified regions while preserving the original context for the rest of the image. We evaluate our method's usability and effectiveness through a user study with artists, comparing our technique against other state-of-the-art image inpainting techniques and editing software for fine-tuning AI-generated imagery.

Due to the three-dimensional nature of CT- or MR-scans, generative modeling of medical images is a particularly challenging task. Existing approaches mostly apply patch-wise, slice-wise, or cascaded generation techniques to fit the high-dimensional data into the limited GPU memory. However, these approaches may introduce artifacts and potentially restrict the model's applicability for certain downstream tasks. This work presents WDM, a wavelet-based medical image synthesis framework that applies a diffusion model on wavelet decomposed images. The presented approach is a simple yet effective way of scaling diffusion models to high resolutions and can be trained on a single 40 GB GPU. Experimental results on BraTS and LIDC-IDRI unconditional image generation at a resolution of 128 times 128 times 128 show state-of-the-art image fidelity (FID) and sample diversity (MS-SSIM) scores compared to GANs, Diffusion Models, and Latent Diffusion Models. Our proposed method is the only one capable of generating high-quality images at a resolution of 256 times 256 times 256.

In computational pathology, understanding and generation have evolved along disparate paths: advanced understanding models already exhibit diagnostic-level competence, whereas generative models largely simulate pixels. Progress remains hindered by three coupled factors: the scarcity of large, high-quality image-text corpora; the lack of precise, fine-grained semantic control, which forces reliance on non-semantic cues; and terminological heterogeneity, where diverse phrasings for the same diagnostic concept impede reliable text conditioning. We introduce UniPath, a semantics-driven pathology image generation framework that leverages mature diagnostic understanding to enable controllable generation. UniPath implements Multi-Stream Control: a Raw-Text stream; a High-Level Semantics stream that uses learnable queries to a frozen pathology MLLM to distill paraphrase-robust Diagnostic Semantic Tokens and to expand prompts into diagnosis-aware attribute bundles; and a Prototype stream that affords component-level morphological control via a prototype bank. On the data front, we curate a 2.65M image-text corpus and a finely annotated, high-quality 68K subset to alleviate data scarcity. For a comprehensive assessment, we establish a four-tier evaluation hierarchy tailored to pathology. Extensive experiments demonstrate UniPath's SOTA performance, including a Patho-FID of 80.9 (51% better than the second-best) and fine-grained semantic control achieving 98.7% of the real-image. The meticulously curated datasets, complete source code, and pre-trained model weights developed in this study will be made openly accessible to the public.

Medical report generation has achieved remarkable advancements yet has still been faced with several challenges. First, the inherent imbalance in the distribution of normal and abnormal cases may lead models to exhibit a biased focus on normal samples, resulting in unreliable diagnoses. Second, the frequent occurrence of common template sentences in the reports may overwhelm the critical abnormal information. Moreover, existing works focus on 2D chest X-rays, leaving CT report generation underexplored due to the high-dimensional nature of CT images and the limited availability of CT-report pairs. Recently, LLM has shown a great ability to generate reliable answers with appropriate prompts, which shed light on addressing the aforementioned challenges. In this paper, we propose Dia-LLaMA, a framework to adapt the LLaMA2-7B for CT report generation by incorporating diagnostic information as guidance prompts. Considering the high dimension of CT, we leverage a pre-trained ViT3D with perceiver to extract the visual information. To tailor the LLM for report generation and emphasize abnormality, we extract additional diagnostic information by referring to a disease prototype memory bank, which is updated during training to capture common disease representations. Furthermore, we introduce disease-aware attention to enable the model to adjust attention for different diseases. Experiments on the chest CT dataset demonstrated that our proposed method outperformed previous methods and achieved state-of-the-art on both clinical efficacy performance and natural language generation metrics. The code will be made publically available.

Recent advances in generative vision-language models (VLMs) have exciting potential implications for AI in radiology, yet VLMs are also known to produce hallucinations, nonsensical text, and other unwanted behaviors that can waste clinicians' time and cause patient harm. Drawing on recent work on direct preference optimization (DPO), we propose a simple method for modifying the behavior of pretrained VLMs performing radiology report generation by suppressing unwanted types of generations. We apply our method to the prevention of hallucinations of prior exams, addressing a long-established problem behavior in models performing chest X-ray report generation. Across our experiments, we find that DPO fine-tuning achieves a 3.2-4.8x reduction in lines hallucinating prior exams while maintaining model performance on clinical accuracy metrics. Our work is, to the best of our knowledge, the first work to apply DPO to medical VLMs, providing a data- and compute- efficient way to suppress problem behaviors while maintaining overall clinical accuracy.

Recently proposed large-scale text-to-image generative models such as DALLcdotE 2, Midjourney, and StableDiffusion can generate high-quality and realistic images from users' prompts. Not limited to the research community, ordinary Internet users enjoy these generative models, and consequently, a tremendous amount of generated images have been shared on the Internet. Meanwhile, today's success of deep learning in the computer vision field owes a lot to images collected from the Internet. These trends lead us to a research question: "will such generated images impact the quality of future datasets and the performance of computer vision models positively or negatively?" This paper empirically answers this question by simulating contamination. Namely, we generate ImageNet-scale and COCO-scale datasets using a state-of-the-art generative model and evaluate models trained with "contaminated" datasets on various tasks, including image classification and image generation. Throughout experiments, we conclude that generated images negatively affect downstream performance, while the significance depends on tasks and the amount of generated images. The generated datasets and the codes for experiments will be publicly released for future research. Generated datasets and source codes are available from https://github.com/moskomule/dataset-contamination.

Despite the ever-increasing interest in applying deep learning (DL) models to medical imaging, the typical scarcity and imbalance of medical datasets can severely impact the performance of DL models. The generation of synthetic data that might be freely shared without compromising patient privacy is a well-known technique for addressing these difficulties. Inpainting algorithms are a subset of DL generative models that can alter one or more regions of an input image while matching its surrounding context and, in certain cases, non-imaging input conditions. Although the majority of inpainting techniques for medical imaging data use generative adversarial networks (GANs), the performance of these algorithms is frequently suboptimal due to their limited output variety, a problem that is already well-known for GANs. Denoising diffusion probabilistic models (DDPMs) are a recently introduced family of generative networks that can generate results of comparable quality to GANs, but with diverse outputs. In this paper, we describe a DDPM to execute multiple inpainting tasks on 2D axial slices of brain MRI with various sequences, and present proof-of-concept examples of its performance in a variety of evaluation scenarios. Our model and a public online interface to try our tool are available at: https://github.com/Mayo-Radiology-Informatics-Lab/MBTI

Generating high-resolution, photo-realistic images has been a long-standing goal in machine learning. Recently, Nguyen et al. (2016) showed one interesting way to synthesize novel images by performing gradient ascent in the latent space of a generator network to maximize the activations of one or multiple neurons in a separate classifier network. In this paper we extend this method by introducing an additional prior on the latent code, improving both sample quality and sample diversity, leading to a state-of-the-art generative model that produces high quality images at higher resolutions (227x227) than previous generative models, and does so for all 1000 ImageNet categories. In addition, we provide a unified probabilistic interpretation of related activation maximization methods and call the general class of models "Plug and Play Generative Networks". PPGNs are composed of 1) a generator network G that is capable of drawing a wide range of image types and 2) a replaceable "condition" network C that tells the generator what to draw. We demonstrate the generation of images conditioned on a class (when C is an ImageNet or MIT Places classification network) and also conditioned on a caption (when C is an image captioning network). Our method also improves the state of the art of Multifaceted Feature Visualization, which generates the set of synthetic inputs that activate a neuron in order to better understand how deep neural networks operate. Finally, we show that our model performs reasonably well at the task of image inpainting. While image models are used in this paper, the approach is modality-agnostic and can be applied to many types of data.

Tumor synthesis can generate examples that AI often misses or over-detects, improving AI performance by training on these challenging cases. However, existing synthesis methods, which are typically unconditional -- generating images from random variables -- or conditioned only by tumor shapes, lack controllability over specific tumor characteristics such as texture, heterogeneity, boundaries, and pathology type. As a result, the generated tumors may be overly similar or duplicates of existing training data, failing to effectively address AI's weaknesses. We propose a new text-driven tumor synthesis approach, termed TextoMorph, that provides textual control over tumor characteristics. This is particularly beneficial for examples that confuse the AI the most, such as early tumor detection (increasing Sensitivity by +8.5%), tumor segmentation for precise radiotherapy (increasing DSC by +6.3%), and classification between benign and malignant tumors (improving Sensitivity by +8.2%). By incorporating text mined from radiology reports into the synthesis process, we increase the variability and controllability of the synthetic tumors to target AI's failure cases more precisely. Moreover, TextoMorph uses contrastive learning across different texts and CT scans, significantly reducing dependence on scarce image-report pairs (only 141 pairs used in this study) by leveraging a large corpus of 34,035 radiology reports. Finally, we have developed rigorous tests to evaluate synthetic tumors, including Text-Driven Visual Turing Test and Radiomics Pattern Analysis, showing that our synthetic tumors is realistic and diverse in texture, heterogeneity, boundaries, and pathology.

The rapid advancement of Artificial Intelligence (AI) in biomedical imaging and radiotherapy is hindered by the limited availability of large imaging data repositories. With recent research and improvements in denoising diffusion probabilistic models (DDPM), high quality synthetic medical scans are now possible. Despite this, there is currently no way of generating multiple related images, such as a corresponding ground truth which can be used to train models, so synthetic scans are often manually annotated before use. This research introduces a novel architecture that is able to generate multiple, related PET-CT-tumour mask pairs using paired networks and conditional encoders. Our approach includes innovative, time step-controlled mechanisms and a `noise-seeding' strategy to improve DDPM sampling consistency. While our model requires a modified perceptual loss function to ensure accurate feature alignment we show generation of clearly aligned synthetic images and improvement in segmentation accuracy with generated images.

Originating from the diffusion phenomenon in physics that describes particle movement, the diffusion generative models inherit the characteristics of stochastic random walk in the data space along the denoising trajectory. However, the intrinsic mutual interference among image regions contradicts the need for practical downstream application scenarios where the preservation of low-level pixel information from given conditioning is desired (e.g., customization tasks like personalized generation and inpainting based on a user-provided single image). In this work, we investigate the diffusion (physics) in diffusion (machine learning) properties and propose our Cyclic One-Way Diffusion (COW) method to control the direction of diffusion phenomenon given a pre-trained frozen diffusion model for versatile customization application scenarios, where the low-level pixel information from the conditioning needs to be preserved. Notably, unlike most current methods that incorporate additional conditions by fine-tuning the base text-to-image diffusion model or learning auxiliary networks, our method provides a novel perspective to understand the task needs and is applicable to a wider range of customization scenarios in a learning-free manner. Extensive experiment results show that our proposed COW can achieve more flexible customization based on strict visual conditions in different application settings. Project page: https://wangruoyu02.github.io/cow.github.io/.

We introduce a new approach for generating realistic 3D models with UV maps through a representation termed "Object Images." This approach encapsulates surface geometry, appearance, and patch structures within a 64x64 pixel image, effectively converting complex 3D shapes into a more manageable 2D format. By doing so, we address the challenges of both geometric and semantic irregularity inherent in polygonal meshes. This method allows us to use image generation models, such as Diffusion Transformers, directly for 3D shape generation. Evaluated on the ABO dataset, our generated shapes with patch structures achieve point cloud FID comparable to recent 3D generative models, while naturally supporting PBR material generation.

Automatic identification of brain lesions from magnetic resonance imaging (MRI) scans of stroke survivors would be a useful aid in patient diagnosis and treatment planning. We propose a multi-modal multi-path convolutional neural network system for automating stroke lesion segmentation. Our system has nine end-to-end UNets that take as input 2-dimensional (2D) slices and examines all three planes with three different normalizations. Outputs from these nine total paths are concatenated into a 3D volume that is then passed to a 3D convolutional neural network to output a final lesion mask. We trained and tested our method on datasets from three sources: Medical College of Wisconsin (MCW), Kessler Foundation (KF), and the publicly available Anatomical Tracings of Lesions After Stroke (ATLAS) dataset. Cross-study validation results (with independent training and validation datasets) were obtained to compare with previous methods based on naive Bayes, random forests, and three recently published convolutional neural networks. Model performance was quantified in terms of the Dice coefficient. Training on the KF and MCW images and testing on the ATLAS images yielded a mean Dice coefficient of 0.54. This was reliably better than the next best previous model, UNet, at 0.47. Reversing the train and test datasets yields a mean Dice of 0.47 on KF and MCW images, whereas the next best UNet reaches 0.45. With all three datasets combined, the current system compared to previous methods also attained a reliably higher cross-validation accuracy. It also achieved high Dice values for many smaller lesions that existing methods have difficulty identifying. Overall, our system is a clear improvement over previous methods for automating stroke lesion segmentation, bringing us an important step closer to the inter-rater accuracy level of human experts.

Melanoma is the most lethal subtype of skin cancer, and early and accurate detection of this disease can greatly improve patients' outcomes. Although machine learning models, especially convolutional neural networks (CNNs), have shown great potential in automating melanoma classification, their diagnostic reliability still suffers due to inconsistent focus on lesion areas. In this study, we analyze the relationship between lesion attention and diagnostic performance, involving masked images, bounding box detection, and transfer learning. We used multiple explainability and sensitivity analysis approaches to investigate how well models aligned their attention with lesion areas and how this alignment correlated with precision, recall, and F1-score. Results showed that models with a higher focus on lesion areas achieved better diagnostic performance, suggesting the potential of interpretable AI in medical diagnostics. This study provides a foundation for developing more accurate and trustworthy melanoma classification models in the future.

Despite the significant progress in diffusion prior-based image restoration, most existing methods apply uniform processing to the entire image, lacking the capability to perform region-customized image restoration according to user instructions. In this work, we propose a new framework, namely InstructRestore, to perform region-adjustable image restoration following human instructions. To achieve this, we first develop a data generation engine to produce training triplets, each consisting of a high-quality image, the target region description, and the corresponding region mask. With this engine and careful data screening, we construct a comprehensive dataset comprising 536,945 triplets to support the training and evaluation of this task. We then examine how to integrate the low-quality image features under the ControlNet architecture to adjust the degree of image details enhancement. Consequently, we develop a ControlNet-like model to identify the target region and allocate different integration scales to the target and surrounding regions, enabling region-customized image restoration that aligns with user instructions. Experimental results demonstrate that our proposed InstructRestore approach enables effective human-instructed image restoration, such as images with bokeh effects and user-instructed local enhancement. Our work advances the investigation of interactive image restoration and enhancement techniques. Data, code, and models will be found at https://github.com/shuaizhengliu/InstructRestore.git.

Recent advances in text-to-image (T2I) diffusion models have enabled increasingly realistic synthesis of vehicle damage, raising concerns about their reliability in automated insurance workflows. The ability to generate crash-like imagery challenges the boundary between authentic and synthetic data, introducing new risks of misuse in fraud or claim manipulation. To address these issues, we propose HERS (Hidden-Pattern Expert Learning for Risk-Specific Damage Adaptation), a framework designed to improve fidelity, controllability, and domain alignment of diffusion-generated damage images. HERS fine-tunes a base diffusion model via domain-specific expert adaptation without requiring manual annotation. Using self-supervised image-text pairs automatically generated by a large language model and T2I pipeline, HERS models each damage category, such as dents, scratches, broken lights, or cracked paint, as a separate expert. These experts are later integrated into a unified multi-damage model that balances specialization with generalization. We evaluate HERS across four diffusion backbones and observe consistent improvements: plus 5.5 percent in text faithfulness and plus 2.3 percent in human preference ratings compared to baselines. Beyond image fidelity, we discuss implications for fraud detection, auditability, and safe deployment of generative models in high-stakes domains. Our findings highlight both the opportunities and risks of domain-specific diffusion, underscoring the importance of trustworthy generation in safety-critical applications such as auto insurance.

Automatic diabetic retinopathy (DR) lesions segmentation makes great sense of assisting ophthalmologists in diagnosis. Although many researches have been conducted on this task, most prior works paid too much attention to the designs of networks instead of considering the pathological association for lesions. Through investigating the pathogenic causes of DR lesions in advance, we found that certain lesions are closed to specific vessels and present relative patterns to each other. Motivated by the observation, we propose a relation transformer block (RTB) to incorporate attention mechanisms at two main levels: a self-attention transformer exploits global dependencies among lesion features, while a cross-attention transformer allows interactions between lesion and vessel features by integrating valuable vascular information to alleviate ambiguity in lesion detection caused by complex fundus structures. In addition, to capture the small lesion patterns first, we propose a global transformer block (GTB) which preserves detailed information in deep network. By integrating the above blocks of dual-branches, our network segments the four kinds of lesions simultaneously. Comprehensive experiments on IDRiD and DDR datasets well demonstrate the superiority of our approach, which achieves competitive performance compared to state-of-the-arts.

Recently, diffusion models have made significant strides in synthesizing realistic 2D human images based on provided text prompts. Building upon this, researchers have extended 2D text-to-image diffusion models into the 3D domain for generating human textures (UV Maps). However, some important problems about UV Map Generative models are still not solved, i.e., how to generate personalized texture maps for any given face image, and how to define and evaluate the quality of these generated texture maps. To solve the above problems, we introduce a novel method, UVMap-ID, which is a controllable and personalized UV Map generative model. Unlike traditional large-scale training methods in 2D, we propose to fine-tune a pre-trained text-to-image diffusion model which is integrated with a face fusion module for achieving ID-driven customized generation. To support the finetuning strategy, we introduce a small-scale attribute-balanced training dataset, including high-quality textures with labeled text and Face ID. Additionally, we introduce some metrics to evaluate the multiple aspects of the textures. Finally, both quantitative and qualitative analyses demonstrate the effectiveness of our method in controllable and personalized UV Map generation. Code is publicly available via https://github.com/twowwj/UVMap-ID.

Recent advancements in image inpainting, particularly through diffusion modeling, have yielded promising outcomes. However, when tested in scenarios involving the completion of images based on the foreground objects, current methods that aim to inpaint an image in an end-to-end manner encounter challenges such as "over-imagination", inconsistency between foreground and background, and limited diversity. In response, we introduce Anywhere, a pioneering multi-agent framework designed to address these issues. Anywhere utilizes a sophisticated pipeline framework comprising various agents such as Visual Language Model (VLM), Large Language Model (LLM), and image generation models. This framework consists of three principal components: the prompt generation module, the image generation module, and the outcome analyzer. The prompt generation module conducts a semantic analysis of the input foreground image, leveraging VLM to predict relevant language descriptions and LLM to recommend optimal language prompts. In the image generation module, we employ a text-guided canny-to-image generation model to create a template image based on the edge map of the foreground image and language prompts, and an image refiner to produce the outcome by blending the input foreground and the template image. The outcome analyzer employs VLM to evaluate image content rationality, aesthetic score, and foreground-background relevance, triggering prompt and image regeneration as needed. Extensive experiments demonstrate that our Anywhere framework excels in foreground-conditioned image inpainting, mitigating "over-imagination", resolving foreground-background discrepancies, and enhancing diversity. It successfully elevates foreground-conditioned image inpainting to produce more reliable and diverse results.

Text-to-Image models such as Stable Diffusion have shown impressive image generation synthesis, thanks to the utilization of large-scale datasets. However, these datasets may contain sexually explicit, copyrighted, or undesirable content, which allows the model to directly generate them. Given that retraining these large models on individual concept deletion requests is infeasible, fine-tuning algorithms have been developed to tackle concept erasing in diffusion models. While these algorithms yield good concept erasure, they all present one of the following issues: 1) the corrupted feature space yields synthesis of disintegrated objects, 2) the initially synthesized content undergoes a divergence in both spatial structure and semantics in the generated images, and 3) sub-optimal training updates heighten the model's susceptibility to utility harm. These issues severely degrade the original utility of generative models. In this work, we present a new approach that solves all of these challenges. We take inspiration from the concept of classifier guidance and propose a surgical update on the classifier guidance term while constraining the drift of the unconditional score term. Furthermore, our algorithm empowers the user to select an alternative to the erasing concept, allowing for more controllability. Our experimental results show that our algorithm not only erases the target concept effectively but also preserves the model's generation capability.

Skin diseases affect millions of people worldwide, across all ethnicities. Increasing diagnosis accessibility requires fair and accurate segmentation and classification of dermatology images. However, the scarcity of annotated medical images, especially for rare diseases and underrepresented skin tones, poses a challenge to the development of fair and accurate models. In this study, we introduce a Fair, Efficient, and Diverse Diffusion-based framework for skin lesion segmentation and malignancy classification. FEDD leverages semantically meaningful feature embeddings learned through a denoising diffusion probabilistic backbone and processes them via linear probes to achieve state-of-the-art performance on Diverse Dermatology Images (DDI). We achieve an improvement in intersection over union of 0.18, 0.13, 0.06, and 0.07 while using only 5%, 10%, 15%, and 20% labeled samples, respectively. Additionally, FEDD trained on 10% of DDI demonstrates malignancy classification accuracy of 81%, 14% higher compared to the state-of-the-art. We showcase high efficiency in data-constrained scenarios while providing fair performance for diverse skin tones and rare malignancy conditions. Our newly annotated DDI segmentation masks and training code can be found on https://github.com/hectorcarrion/fedd.

Current deep learning-based approaches to lesion segmentation in neuroimaging often depend on high-resolution images and extensive annotated data, limiting clinical applicability. This paper introduces a novel synthetic data framework tailored for stroke lesion segmentation, expanding the SynthSeg methodology to incorporate lesion-specific augmentations that simulate diverse pathological features. Using a modified nnUNet architecture, our approach trains models with label maps from healthy and stroke datasets, facilitating segmentation across both normal and pathological tissue without reliance on specific sequence-based training. Evaluation across in-domain and out-of-domain (OOD) datasets reveals that our method matches state-of-the-art performance within the training domain and significantly outperforms existing methods on OOD data. By minimizing dependence on large annotated datasets and allowing for cross-sequence applicability, our framework holds potential to improve clinical neuroimaging workflows, particularly in stroke pathology. PyTorch training code and weights are publicly available at https://github.com/liamchalcroft/SynthStroke, along with an SPM toolbox featuring a plug-and-play model at https://github.com/liamchalcroft/SynthStrokeSPM.

Personalizing generative models offers a way to guide image generation with user-provided references. Current personalization methods can invert an object or concept into the textual conditioning space and compose new natural sentences for text-to-image diffusion models. However, representing and editing specific visual attributes such as material, style, and layout remains a challenge, leading to a lack of disentanglement and editability. To address this problem, we propose a novel approach that leverages the step-by-step generation process of diffusion models, which generate images from low to high frequency information, providing a new perspective on representing, generating, and editing images. We develop the Prompt Spectrum Space P*, an expanded textual conditioning space, and a new image representation method called \sysname. ProSpect represents an image as a collection of inverted textual token embeddings encoded from per-stage prompts, where each prompt corresponds to a specific generation stage (i.e., a group of consecutive steps) of the diffusion model. Experimental results demonstrate that P* and ProSpect offer better disentanglement and controllability compared to existing methods. We apply ProSpect in various personalized attribute-aware image generation applications, such as image-guided or text-driven manipulations of materials, style, and layout, achieving previously unattainable results from a single image input without fine-tuning the diffusion models. Our source code is available athttps://github.com/zyxElsa/ProSpect.

Conditional generative models typically demand large annotated training sets to achieve high-quality synthesis. As a result, there has been significant interest in designing models that perform plug-and-play generation, i.e., to use a predefined or pretrained model, which is not explicitly trained on the generative task, to guide the generative process (e.g., using language). However, such guidance is typically useful only towards synthesizing high-level semantics rather than editing fine-grained details as in image-to-image translation tasks. To this end, and capitalizing on the powerful fine-grained generative control offered by the recent diffusion-based generative models, we introduce Steered Diffusion, a generalized framework for photorealistic zero-shot conditional image generation using a diffusion model trained for unconditional generation. The key idea is to steer the image generation of the diffusion model at inference time via designing a loss using a pre-trained inverse model that characterizes the conditional task. This loss modulates the sampling trajectory of the diffusion process. Our framework allows for easy incorporation of multiple conditions during inference. We present experiments using steered diffusion on several tasks including inpainting, colorization, text-guided semantic editing, and image super-resolution. Our results demonstrate clear qualitative and quantitative improvements over state-of-the-art diffusion-based plug-and-play models while adding negligible additional computational cost.

Generative models have reached an advanced stage where they can produce remarkably realistic images. However, this remarkable generative capability also introduces the risk of disseminating false or misleading information. Notably, existing image detectors for generated images encounter challenges such as low accuracy and limited generalization. This paper seeks to address this issue by seeking a representation with strong generalization capabilities to enhance the detection of generated images. Our investigation has revealed that real and generated images display distinct latent Gaussian representations when subjected to an inverse diffusion process within a pre-trained diffusion model. Exploiting this disparity, we can amplify subtle artifacts in generated images. Building upon this insight, we introduce a novel image representation known as Diffusion Noise Feature (DNF). DNF is extracted from the estimated noise generated during the inverse diffusion process. A simple classifier, e.g., ResNet50, trained on DNF achieves high accuracy, robustness, and generalization capabilities for detecting generated images (even the corresponding generator is built with datasets/structures that are not seen during the classifier's training). We conducted experiments using four training datasets and five testsets, achieving state-of-the-art detection performance.

Seismic advances in generative AI algorithms for imagery, text, and other data types has led to the temptation to use synthetic data to train next-generation models. Repeating this process creates an autophagous (self-consuming) loop whose properties are poorly understood. We conduct a thorough analytical and empirical analysis using state-of-the-art generative image models of three families of autophagous loops that differ in how fixed or fresh real training data is available through the generations of training and in whether the samples from previous generation models have been biased to trade off data quality versus diversity. Our primary conclusion across all scenarios is that without enough fresh real data in each generation of an autophagous loop, future generative models are doomed to have their quality (precision) or diversity (recall) progressively decrease. We term this condition Model Autophagy Disorder (MAD), making analogy to mad cow disease.

Chest X-ray imaging (CXR) is an important diagnostic tool used in hospitals to assess patient conditions and monitor changes over time. Generative models, specifically diffusion-based models, have shown promise in generating realistic synthetic X-rays. However, these models mainly focus on conditional generation using single-time-point data, i.e., typically CXRs taken at a specific time with their corresponding reports, limiting their clinical utility, particularly for capturing temporal changes. To address this limitation, we propose a novel framework, EHRXDiff, which predicts future CXR images by integrating previous CXRs with subsequent medical events, e.g., prescriptions, lab measures, etc. Our framework dynamically tracks and predicts disease progression based on a latent diffusion model, conditioned on the previous CXR image and a history of medical events. We comprehensively evaluate the performance of our framework across three key aspects, including clinical consistency, demographic consistency, and visual realism. We demonstrate that our framework generates high-quality, realistic future images that capture potential temporal changes, suggesting its potential for further development as a clinical simulation tool. This could offer valuable insights for patient monitoring and treatment planning in the medical field.

In medical imaging, the diffusion models have shown great potential in synthetic image generation tasks. However, these models often struggle with the interpretable connections between the generated and existing images and could create illusions. To address these challenges, our research proposes a novel diffusion-based generative model based on deformation diffusion and recovery. This model, named Deformation-Recovery Diffusion Model (DRDM), diverges from traditional score/intensity and latent feature-based approaches, emphasizing morphological changes through deformation fields rather than direct image synthesis. This is achieved by introducing a topological-preserving deformation field generation method, which randomly samples and integrates a set of multi-scale Deformation Vector Fields (DVF). DRDM is trained to learn to recover unreasonable deformation components, thereby restoring each randomly deformed image to a realistic distribution. These innovations facilitate the generation of diverse and anatomically plausible deformations, enhancing data augmentation and synthesis for further analysis in downstream tasks, such as few-shot learning and image registration. Experimental results in cardiac MRI and pulmonary CT show DRDM is capable of creating diverse, large (over 10\% image size deformation scale), and high-quality (negative rate of the Jacobian matrix's determinant is lower than 1\%) deformation fields. The further experimental results in downstream tasks, 2D image segmentation and 3D image registration, indicate significant improvements resulting from DRDM, showcasing the potential of our model to advance image manipulation and synthesis in medical imaging and beyond. Project page: https://jianqingzheng.github.io/def_diff_rec/

Medical image segmentation has recently demonstrated impressive progress with deep neural networks, yet the heterogeneous modalities and scarcity of mask annotations limit the development of segmentation models on unannotated modalities. This paper investigates a new paradigm for leveraging generative models in medical applications: controllably synthesizing data for unannotated modalities, without requiring registered data pairs. Specifically, we make the following contributions in this paper: (i) we collect and curate a large-scale radiology image-text dataset, MedGen-1M, comprising modality labels, attributes, region, and organ information, along with a subset of organ mask annotations, to support research in controllable medical image generation; (ii) we propose a diffusion-based data engine, termed MRGen, which enables generation conditioned on text prompts and masks, synthesizing MR images for diverse modalities lacking mask annotations, to train segmentation models on unannotated modalities; (iii) we conduct extensive experiments across various modalities, illustrating that our data engine can effectively synthesize training samples and extend MRI segmentation towards unannotated modalities.

Vector-quantized image modeling has shown great potential in synthesizing high-quality images. However, generating high-resolution images remains a challenging task due to the quadratic computational overhead of the self-attention process. In this study, we seek to explore a more efficient two-stage framework for high-resolution image generation with improvements in the following three aspects. (1) Based on the observation that the first quantization stage has solid local property, we employ a local attention-based quantization model instead of the global attention mechanism used in previous methods, leading to better efficiency and reconstruction quality. (2) We emphasize the importance of multi-grained feature interaction during image generation and introduce an efficient attention mechanism that combines global attention (long-range semantic consistency within the whole image) and local attention (fined-grained details). This approach results in faster generation speed, higher generation fidelity, and improved resolution. (3) We propose a new generation pipeline incorporating autoencoding training and autoregressive generation strategy, demonstrating a better paradigm for image synthesis. Extensive experiments demonstrate the superiority of our approach in high-quality and high-resolution image reconstruction and generation.

Whole-slide images (WSIs) are gigapixel-scale digital scans of histopathology tissue and serve as the primary basis for cancer diagnosis. Existing histopathology generative models operate at the patch scale, producing fixed-size tiles of at most 1024times1024 pixels which encompass only a small fraction of the WSI. In contrast, text reports for clinical diagnoses and slide-level diagnostic labels -- the supervision that exists at scale -- operate at the whole-slide level. We present BigCell, the first approach to generate coherent whole-slide histopathology images at native gigapixel resolution. BigCell trains a flow-matching transformer at 2048times2048 pixels on over 120,000 publicly available WSIs spanning multiple organ types. Conditioning on embeddings from pathology foundation models and using an inference-time sliding-window pipeline, BigCell generates coherent images of up to 32,768times32,768 pixels, outperforming prior tile generators on both tile-level and slide-level fidelity metrics. To make gigapixel synthesis practical, we introduce an adaptive scheduling strategy that prioritizes important slide regions, speeding up image generation by over 3\ttimes with minimal quality degradation. Furthermore, we propose the first text-to-image synthesis at 8k resolution by training a separate model that produces dense conditioning grids directly from pathology text reports. We demonstrate that augmenting with synthetic samples improves slide-level few-shot classification performance by up to 18 % over baselines trained on real data.

This paper contributes to the "BraTS 2024 Brain MR Image Synthesis Challenge" and presents a conditional Wavelet Diffusion Model (cWDM) for directly solving a paired image-to-image translation task on high-resolution volumes. While deep learning-based brain tumor segmentation models have demonstrated clear clinical utility, they typically require MR scans from various modalities (T1, T1ce, T2, FLAIR) as input. However, due to time constraints or imaging artifacts, some of these modalities may be missing, hindering the application of well-performing segmentation algorithms in clinical routine. To address this issue, we propose a method that synthesizes one missing modality image conditioned on three available images, enabling the application of downstream segmentation models. We treat this paired image-to-image translation task as a conditional generation problem and solve it by combining a Wavelet Diffusion Model for high-resolution 3D image synthesis with a simple conditioning strategy. This approach allows us to directly apply our model to full-resolution volumes, avoiding artifacts caused by slice- or patch-wise data processing. While this work focuses on a specific application, the presented method can be applied to all kinds of paired image-to-image translation problems, such as CT leftrightarrow MR and MR leftrightarrow PET translation, or mask-conditioned anatomically guided image generation.

We present Condition-Aware Neural Network (CAN), a new method for adding control to image generative models. In parallel to prior conditional control methods, CAN controls the image generation process by dynamically manipulating the weight of the neural network. This is achieved by introducing a condition-aware weight generation module that generates conditional weight for convolution/linear layers based on the input condition. We test CAN on class-conditional image generation on ImageNet and text-to-image generation on COCO. CAN consistently delivers significant improvements for diffusion transformer models, including DiT and UViT. In particular, CAN combined with EfficientViT (CaT) achieves 2.78 FID on ImageNet 512x512, surpassing DiT-XL/2 while requiring 52x fewer MACs per sampling step.

Existing text-guided segmentation models in the medical domain cover only a narrow set of anatomical structures and lesions in chest X-rays (CXRs), and most of them assume that the queried target is always present in the image. Instruction-guided lesion segmentation (ILS) was introduced to overcome these limitations by segmenting diverse lesion types from simple user instructions while also recognizing when the queried lesion is absent, and ROSALIA was proposed as the first model for this task. However, the masks produced by ROSALIA remain of limited quality, often carrying scattered noise. Moreover, ROSALIA predicts the mask in a single shot, which differs fundamentally from how radiologists perceive and delineate lesions in practice. A radiologist first surveys the entire thorax, then localizes the approximate region of abnormality, and only then refines the lesion contour. Motivated by this coarse-to-fine, multi-level perception process, we present XFlow, a workflow model for ILS that combines box-based localization with multi-turn point refinement. XFlow detects the lungs, decides whether the queried finding is present in each of them, and prompts a fine-tuned SAM with the lesion box for an initial mask. It then corrects that mask through point prompts until its boundary follows the lesion, leaving every intermediate decision visible. Our experiments show that XFlow achieves the best segmentation quality on both internal and external evaluation. Notably, it surpasses ROSALIA in segmentation quality even when the two are trained on the same lesion annotations. Code and model weights will be made publicly available.

Human organs constantly undergo anatomical changes due to a complex mix of short-term (e.g., heartbeat) and long-term (e.g., aging) factors. Evidently, prior knowledge of these factors will be beneficial when modeling their future state, i.e., via image generation. However, most of the medical image generation tasks only rely on the input from a single image, thus ignoring the sequential dependency even when longitudinal data is available. Sequence-aware deep generative models, where model input is a sequence of ordered and timestamped images, are still underexplored in the medical imaging domain that is featured by several unique challenges: 1) Sequences with various lengths; 2) Missing data or frame, and 3) High dimensionality. To this end, we propose a sequence-aware diffusion model (SADM) for the generation of longitudinal medical images. Recently, diffusion models have shown promising results in high-fidelity image generation. Our method extends this new technique by introducing a sequence-aware transformer as the conditional module in a diffusion model. The novel design enables learning longitudinal dependency even with missing data during training and allows autoregressive generation of a sequence of images during inference. Our extensive experiments on 3D longitudinal medical images demonstrate the effectiveness of SADM compared with baselines and alternative methods. The code is available at https://github.com/ubc-tea/SADM-Longitudinal-Medical-Image-Generation.

Controllable generative models of 3D medical images can synthesize volumes with specified clinical attributes, but this demands samples that are simultaneously high-fidelity, natively 3D, and faithful to the requested conditioning. We present CONFLUX, a latent diffusion model for chest computed tomography (CT): a 3D variational autoencoder compresses each volume, and a rectified-flow transformer generates in the latent space. Generation is conditioned on structured radiological metadata (18 abnormality findings, sex, age, and reconstruction kernel) through adaptive layer normalization. The model leads strong volumetric baselines on tri-planar Frechet distance (FID 32.3 vs. 74.6 for MAISI) while exposing direct control over clinical attributes. To strengthen that control we add an online reinforcement-learning post-training stage (group-relative policy optimization) that rewards how reliably a classifier recovers the requested findings from each generated volume. Judged by a separate, independent classifier, post-training removes 47% of the shortfall relative to real-scan reliability. We release the model and a ~200k synthetic chest-CT dataset with conditioning metadata spanning a wide variety of clinical findings.

Text-to-image diffusion generative models can generate high quality images at the cost of tedious prompt engineering. Controllability can be improved by introducing layout conditioning, however existing methods lack layout editing ability and fine-grained control over object attributes. The concept of multi-layer generation holds great potential to address these limitations, however generating image instances concurrently to scene composition limits control over fine-grained object attributes, relative positioning in 3D space and scene manipulation abilities. In this work, we propose a novel multi-stage generation paradigm that is designed for fine-grained control, flexibility and interactivity. To ensure control over instance attributes, we devise a novel training paradigm to adapt a diffusion model to generate isolated scene components as RGBA images with transparency information. To build complex images, we employ these pre-generated instances and introduce a multi-layer composite generation process that smoothly assembles components in realistic scenes. Our experiments show that our RGBA diffusion model is capable of generating diverse and high quality instances with precise control over object attributes. Through multi-layer composition, we demonstrate that our approach allows to build and manipulate images from highly complex prompts with fine-grained control over object appearance and location, granting a higher degree of control than competing methods.

Diffusion models have achieved remarkable success in generating realistic images but suffer from generating accurate human hands, such as incorrect finger counts or irregular shapes. This difficulty arises from the complex task of learning the physical structure and pose of hands from training images, which involves extensive deformations and occlusions. For correct hand generation, our paper introduces a lightweight post-processing solution called HandRefiner. HandRefiner employs a conditional inpainting approach to rectify malformed hands while leaving other parts of the image untouched. We leverage the hand mesh reconstruction model that consistently adheres to the correct number of fingers and hand shape, while also being capable of fitting the desired hand pose in the generated image. Given a generated failed image due to malformed hands, we utilize ControlNet modules to re-inject such correct hand information. Additionally, we uncover a phase transition phenomenon within ControlNet as we vary the control strength. It enables us to take advantage of more readily available synthetic data without suffering from the domain gap between realistic and synthetic hands. Experiments demonstrate that HandRefiner can significantly improve the generation quality quantitatively and qualitatively. The code is available at https://github.com/wenquanlu/HandRefiner .

Identifying, tracking, and predicting wound heal-stage progression is a fundamental task towards proper diagnosis, effective treatment, facilitating healing, and reducing pain. Traditionally, a medical expert might observe a wound to determine the current healing state and recommend treatment. However, sourcing experts who can produce such a diagnosis solely from visual indicators can be difficult, time-consuming and expensive. In addition, lesions may take several weeks to undergo the healing process, demanding resources to monitor and diagnose continually. Automating this task can be challenging; datasets that follow wound progression from onset to maturation are small, rare, and often collected without computer vision in mind. To tackle these challenges, we introduce a self-supervised learning scheme composed of (a) learning embeddings of wound's temporal dynamics, (b) clustering for automatic stage discovery, and (c) fine-tuned classification. The proposed self-supervised and flexible learning framework is biologically inspired and trained on a small dataset with zero human labeling. The HealNet framework achieved high pre-text and downstream classification accuracy; when evaluated on held-out test data, HealNet achieved 97.7% pre-text accuracy and 90.62% heal-stage classification accuracy.

Text-to-Image (T2I) generation is primarily driven by Diffusion Models (DM) which rely on random Gaussian noise. Thus, like playing the slots at a casino, a DM will produce different results given the same user-defined inputs. This imposes a gambler's burden: To perform multiple generation cycles to obtain a satisfactory result. However, even though DMs use stochastic sampling to seed generation, the distribution of generated content quality highly depends on the prompt and the generative ability of a DM with respect to it. To account for this, we propose Naïve PAINE for improving the generative quality of Diffusion Models by leveraging T2I preference benchmarks. We directly predict the numerical quality of an image from the initial noise and given prompt. Naïve PAINE then selects a handful of quality noises and forwards them to the DM for generation. Further, Naïve PAINE provides feedback on the DM generative quality given the prompt and is lightweight enough to seamlessly fit into existing DM pipelines. Experimental results demonstrate that Naïve PAINE outperforms existing approaches on several prompt corpus benchmarks.

The digitization of histology slides has revolutionized pathology, providing massive datasets for cancer diagnosis and research. Contrastive self-supervised and vision-language models have been shown to effectively mine large pathology datasets to learn discriminative representations. On the other hand, generative models, capable of synthesizing realistic and diverse images, present a compelling solution to address unique problems in pathology that involve synthesizing images; overcoming annotated data scarcity, enabling privacy-preserving data sharing, and performing inherently generative tasks, such as virtual staining. We introduce PixCell, the first diffusion-based generative foundation model for histopathology. We train PixCell on PanCan-30M, a vast, diverse dataset derived from 69,184 H\&E-stained whole slide images covering various cancer types. We employ a progressive training strategy and a self-supervision-based conditioning that allows us to scale up training without any annotated data. PixCell generates diverse and high-quality images across multiple cancer types, which we find can be used in place of real data to train a self-supervised discriminative model. Synthetic images shared between institutions are subject to fewer regulatory barriers than would be the case with real clinical images. Furthermore, we showcase the ability to precisely control image generation using a small set of annotated images, which can be used for both data augmentation and educational purposes. Testing on a cell segmentation task, a mask-guided PixCell enables targeted data augmentation, improving downstream performance. Finally, we demonstrate PixCell's ability to use H\&E structural staining to infer results from molecular marker studies; we use this capability to infer IHC staining from H\&E images. Our trained models are publicly released to accelerate research in computational pathology.

Recent advances in text-to-image generation with diffusion models present transformative capabilities in image quality. However, user controllability of the generated image, and fast adaptation to new tasks still remains an open challenge, currently mostly addressed by costly and long re-training and fine-tuning or ad-hoc adaptations to specific image generation tasks. In this work, we present MultiDiffusion, a unified framework that enables versatile and controllable image generation, using a pre-trained text-to-image diffusion model, without any further training or finetuning. At the center of our approach is a new generation process, based on an optimization task that binds together multiple diffusion generation processes with a shared set of parameters or constraints. We show that MultiDiffusion can be readily applied to generate high quality and diverse images that adhere to user-provided controls, such as desired aspect ratio (e.g., panorama), and spatial guiding signals, ranging from tight segmentation masks to bounding boxes. Project webpage: https://multidiffusion.github.io

Dynamic contrast-enhanced breast MRI (DCE-MRI) is rich in anatomical and perfusion information, but its reliance on gadolinium-based contrast agents raises safety concerns and adds cost. Virtual contrast enhancement, synthesizing post-contrast from pre-contrast images, is a promising alternative. We address the MAMA-SYNTH challenge task of predicting peak-enhancement breast MRI. Rather than adopting the full machinery of diffusion or flow matching, we observe that under a rectified, straight-line path the generative process collapses to a single difference prediction: the synthetic peak image is the pre-contrast image plus a predicted enhancement map, recovered in one forward pass. Around this we build Anguinus Sculpturae, a compositional pipeline in which nnU-Net segmentations of lesion, foreground and breast region guide two generators - one optimized for global fidelity, one for lesion structure through an asymmetric Tversky term routed via a frozen segmenter - composited region-wise with Gaussian-weighted blending. On the held-out Duke subset of MAMA-MIA our model achieves the best FRD and Dice among all evaluated variants, showing that single-step difference prediction with segmentation guidance suffices to recover both global fidelity and lesion structure. Code is available at https://github.com/MIC-DKFZ/AnguinusSculpturae.

Recent one image to 3D generation methods commonly adopt Score Distillation Sampling (SDS). Despite the impressive results, there are multiple deficiencies including multi-view inconsistency, over-saturated and over-smoothed textures, as well as the slow generation speed. To address these deficiencies, we present Repaint123 to alleviate multi-view bias as well as texture degradation and speed up the generation process. The core idea is to combine the powerful image generation capability of the 2D diffusion model and the texture alignment ability of the repainting strategy for generating high-quality multi-view images with consistency. We further propose visibility-aware adaptive repainting strength for overlap regions to enhance the generated image quality in the repainting process. The generated high-quality and multi-view consistent images enable the use of simple Mean Square Error (MSE) loss for fast 3D content generation. We conduct extensive experiments and show that our method has a superior ability to generate high-quality 3D content with multi-view consistency and fine textures in 2 minutes from scratch. Code is at https://github.com/junwuzhang19/repaint123.

This paper presents a comprehensive systematic review of generative models (GANs, VAEs, DMs, and LLMs) used to synthesize various medical data types, including imaging (dermoscopic, mammographic, ultrasound, CT, MRI, and X-ray), text, time-series, and tabular data (EHR). Unlike previous narrowly focused reviews, our study encompasses a broad array of medical data modalities and explores various generative models. Our search strategy queries databases such as Scopus, PubMed, and ArXiv, focusing on recent works from January 2021 to November 2023, excluding reviews and perspectives. This period emphasizes recent advancements beyond GANs, which have been extensively covered previously. The survey reveals insights from three key aspects: (1) Synthesis applications and purpose of synthesis, (2) generation techniques, and (3) evaluation methods. It highlights clinically valid synthesis applications, demonstrating the potential of synthetic data to tackle diverse clinical requirements. While conditional models incorporating class labels, segmentation masks and image translations are prevalent, there is a gap in utilizing prior clinical knowledge and patient-specific context, suggesting a need for more personalized synthesis approaches and emphasizing the importance of tailoring generative approaches to the unique characteristics of medical data. Additionally, there is a significant gap in using synthetic data beyond augmentation, such as for validation and evaluation of downstream medical AI models. The survey uncovers that the lack of standardized evaluation methodologies tailored to medical images is a barrier to clinical application, underscoring the need for in-depth evaluation approaches, benchmarking, and comparative studies to promote openness and collaboration.

To synthesize high-fidelity samples, diffusion models typically require auxiliary data to guide the generation process. However, it is impractical to procure the painstaking patch-level annotation effort required in specialized domains like histopathology and satellite imagery; it is often performed by domain experts and involves hundreds of millions of patches. Modern-day self-supervised learning (SSL) representations encode rich semantic and visual information. In this paper, we posit that such representations are expressive enough to act as proxies to fine-grained human labels. We introduce a novel approach that trains diffusion models conditioned on embeddings from SSL. Our diffusion models successfully project these features back to high-quality histopathology and remote sensing images. In addition, we construct larger images by assembling spatially consistent patches inferred from SSL embeddings, preserving long-range dependencies. Augmenting real data by generating variations of real images improves downstream classifier accuracy for patch-level and larger, image-scale classification tasks. Our models are effective even on datasets not encountered during training, demonstrating their robustness and generalizability. Generating images from learned embeddings is agnostic to the source of the embeddings. The SSL embeddings used to generate a large image can either be extracted from a reference image, or sampled from an auxiliary model conditioned on any related modality (e.g. class labels, text, genomic data). As proof of concept, we introduce the text-to-large image synthesis paradigm where we successfully synthesize large pathology and satellite images out of text descriptions.

The prevalent use of commercial and open-source diffusion models (DMs) for text-to-image generation prompts risk mitigation to prevent undesired behaviors. Existing concept erasing methods in academia are all based on full parameter or specification-based fine-tuning, from which we observe the following issues: 1) Generation alternation towards erosion: Parameter drift during target elimination causes alternations and potential deformations across all generations, even eroding other concepts at varying degrees, which is more evident with multi-concept erased; 2) Transfer inability & deployment inefficiency: Previous model-specific erasure impedes the flexible combination of concepts and the training-free transfer towards other models, resulting in linear cost growth as the deployment scenarios increase. To achieve non-invasive, precise, customizable, and transferable elimination, we ground our erasing framework on one-dimensional adapters to erase multiple concepts from most DMs at once across versatile erasing applications. The concept-SemiPermeable structure is injected as a Membrane (SPM) into any DM to learn targeted erasing, and meantime the alteration and erosion phenomenon is effectively mitigated via a novel Latent Anchoring fine-tuning strategy. Once obtained, SPMs can be flexibly combined and plug-and-play for other DMs without specific re-tuning, enabling timely and efficient adaptation to diverse scenarios. During generation, our Facilitated Transport mechanism dynamically regulates the permeability of each SPM to respond to different input prompts, further minimizing the impact on other concepts. Quantitative and qualitative results across ~40 concepts, 7 DMs and 4 erasing applications have demonstrated the superior erasing of SPM. Our code and pre-tuned SPMs will be available on the project page https://lyumengyao.github.io/projects/spm.

Current subject-driven image generation methods encounter significant challenges in person-centric image generation. The reason is that they learn the semantic scene and person generation by fine-tuning a common pre-trained diffusion, which involves an irreconcilable training imbalance. Precisely, to generate realistic persons, they need to sufficiently tune the pre-trained model, which inevitably causes the model to forget the rich semantic scene prior and makes scene generation over-fit to the training data. Moreover, even with sufficient fine-tuning, these methods can still not generate high-fidelity persons since joint learning of the scene and person generation also lead to quality compromise. In this paper, we propose Face-diffuser, an effective collaborative generation pipeline to eliminate the above training imbalance and quality compromise. Specifically, we first develop two specialized pre-trained diffusion models, i.e., Text-driven Diffusion Model (TDM) and Subject-augmented Diffusion Model (SDM), for scene and person generation, respectively. The sampling process is divided into three sequential stages, i.e., semantic scene construction, subject-scene fusion, and subject enhancement. The first and last stages are performed by TDM and SDM respectively. The subject-scene fusion stage, that is the collaboration achieved through a novel and highly effective mechanism, Saliency-adaptive Noise Fusion (SNF). Specifically, it is based on our key observation that there exists a robust link between classifier-free guidance responses and the saliency of generated images. In each time step, SNF leverages the unique strengths of each model and allows for the spatial blending of predicted noises from both models automatically in a saliency-aware manner. Extensive experiments confirm the impressive effectiveness and robustness of the Face-diffuser.

3D generation methods have shown visually compelling results powered by diffusion image priors. However, they often fail to produce realistic geometric details, resulting in overly smooth surfaces or geometric details inaccurately baked in albedo maps. To address this, we introduce a new method that incorporates touch as an additional modality to improve the geometric details of generated 3D assets. We design a lightweight 3D texture field to synthesize visual and tactile textures, guided by 2D diffusion model priors on both visual and tactile domains. We condition the visual texture generation on high-resolution tactile normals and guide the patch-based tactile texture refinement with a customized TextureDreambooth. We further present a multi-part generation pipeline that enables us to synthesize different textures across various regions. To our knowledge, we are the first to leverage high-resolution tactile sensing to enhance geometric details for 3D generation tasks. We evaluate our method in both text-to-3D and image-to-3D settings. Our experiments demonstrate that our method provides customized and realistic fine geometric textures while maintaining accurate alignment between two modalities of vision and touch.

Large-scale text-to-image generative models have been a revolutionary breakthrough in the evolution of generative AI, allowing us to synthesize diverse images that convey highly complex visual concepts. However, a pivotal challenge in leveraging such models for real-world content creation tasks is providing users with control over the generated content. In this paper, we present a new framework that takes text-to-image synthesis to the realm of image-to-image translation -- given a guidance image and a target text prompt, our method harnesses the power of a pre-trained text-to-image diffusion model to generate a new image that complies with the target text, while preserving the semantic layout of the source image. Specifically, we observe and empirically demonstrate that fine-grained control over the generated structure can be achieved by manipulating spatial features and their self-attention inside the model. This results in a simple and effective approach, where features extracted from the guidance image are directly injected into the generation process of the target image, requiring no training or fine-tuning and applicable for both real or generated guidance images. We demonstrate high-quality results on versatile text-guided image translation tasks, including translating sketches, rough drawings and animations into realistic images, changing of the class and appearance of objects in a given image, and modifications of global qualities such as lighting and color.

Knowledge Graph (KG) plays a crucial role in Medical Report Generation (MRG) because it reveals the relations among diseases and thus can be utilized to guide the generation process. However, constructing a comprehensive KG is labor-intensive and its applications on the MRG process are under-explored. In this study, we establish a complete KG on chest X-ray imaging that includes 137 types of diseases and abnormalities. Based on this KG, we find that the current MRG data sets exhibit a long-tailed problem in disease distribution. To mitigate this problem, we introduce a novel augmentation strategy that enhances the representation of disease types in the tail-end of the distribution. We further design a two-stage MRG approach, where a classifier is first trained to detect whether the input images exhibit any abnormalities. The classified images are then independently fed into two transformer-based generators, namely, ``disease-specific generator" and ``disease-free generator" to generate the corresponding reports. To enhance the clinical evaluation of whether the generated reports correctly describe the diseases appearing in the input image, we propose diverse sensitivity (DS), a new metric that checks whether generated diseases match ground truth and measures the diversity of all generated diseases. Results show that the proposed two-stage generation framework and augmentation strategies improve DS by a considerable margin, indicating a notable reduction in the long-tailed problem associated with under-represented diseases.

Inferring contrast enhancement from one pre-contrast breast MRI slice is underdetermined: post-contrast appearance contains physiological information that is not uniquely encoded in baseline anatomy. Optimizing only paired pixel fidelity can suppress uncertain lesion enhancement, whereas adversarial or stochastic generative objectives can favor realistic post-contrast appearance without guaranteeing patient-specific lesion fidelity. We introduce MIRAGE, a residual 2D U-Net that combines global reconstruction and perceptual losses with three forms of lesion-aware supervision available only during training: an asymmetric penalty for missed tumor enhancement, multi-scale auxiliary tumor segmentation, and guidance through a frozen post-contrast tumor segmentation nnU-Net. We evaluate the method on 301 cases from the multi-centre MAMA-SYNTH data using eight complementary image-, region-, radiomics-, and segmentation-based metrics. MIRAGE ranks first on six metrics and markedly improves downstream lesion localization over tuned pix2pix, conditional diffusion, and latent bridge-matching baselines. The generative alternatives retain advantages in LPIPS or contrast classification, revealing a clear fidelity-utility trade-off. Leave-one-in and leave-one-out ablations show that the losses are partly redundant for lesion localization but exert distinct effects on appearance, radiomics, and boundary accuracy. These results support task-aware synthesis while also showing that its apparent optimality is conditional on the downstream models and metrics used to define utility.

Recent progress in image generation has sparked research into controlling these models through condition signals, with various methods addressing specific challenges in conditional generation. Instead of proposing another specialized technique, we introduce a simple, unified framework to handle diverse conditional generation tasks involving a specific image-condition correlation. By learning a joint distribution over a correlated image pair (e.g. image and depth) with a diffusion model, our approach enables versatile capabilities via different inference-time sampling schemes, including controllable image generation (e.g. depth to image), estimation (e.g. image to depth), signal guidance, joint generation (image & depth), and coarse control. Previous attempts at unification often introduce significant complexity through multi-stage training, architectural modification, or increased parameter counts. In contrast, our simple formulation requires a single, computationally efficient training stage, maintains the standard model input, and adds minimal learned parameters (15% of the base model). Moreover, our model supports additional capabilities like non-spatially aligned and coarse conditioning. Extensive results show that our single model can produce comparable results with specialized methods and better results than prior unified methods. We also demonstrate that multiple models can be effectively combined for multi-signal conditional generation.

Generating synthetic datasets for training face recognition models is challenging because dataset generation entails more than creating high fidelity images. It involves generating multiple images of same subjects under different factors (e.g., variations in pose, illumination, expression, aging and occlusion) which follows the real image conditional distribution. Previous works have studied the generation of synthetic datasets using GAN or 3D models. In this work, we approach the problem from the aspect of combining subject appearance (ID) and external factor (style) conditions. These two conditions provide a direct way to control the inter-class and intra-class variations. To this end, we propose a Dual Condition Face Generator (DCFace) based on a diffusion model. Our novel Patch-wise style extractor and Time-step dependent ID loss enables DCFace to consistently produce face images of the same subject under different styles with precise control. Face recognition models trained on synthetic images from the proposed DCFace provide higher verification accuracies compared to previous works by 6.11% on average in 4 out of 5 test datasets, LFW, CFP-FP, CPLFW, AgeDB and CALFW. Code is available at https://github.com/mk-minchul/dcface

This paper explores advancements in high-fidelity personalized image generation through the utilization of pre-trained text-to-image diffusion models. While previous approaches have made significant strides in generating versatile scenes based on text descriptions and a few input images, challenges persist in maintaining the subject fidelity within the generated images. In this work, we introduce an innovative algorithm named HiFi Tuner to enhance the appearance preservation of objects during personalized image generation. Our proposed method employs a parameter-efficient fine-tuning framework, comprising a denoising process and a pivotal inversion process. Key enhancements include the utilization of mask guidance, a novel parameter regularization technique, and the incorporation of step-wise subject representations to elevate the sample fidelity. Additionally, we propose a reference-guided generation approach that leverages the pivotal inversion of a reference image to mitigate unwanted subject variations and artifacts. We further extend our method to a novel image editing task: substituting the subject in an image through textual manipulations. Experimental evaluations conducted on the DreamBooth dataset using the Stable Diffusion model showcase promising results. Fine-tuning solely on textual embeddings improves CLIP-T score by 3.6 points and improves DINO score by 9.6 points over Textual Inversion. When fine-tuning all parameters, HiFi Tuner improves CLIP-T score by 1.2 points and improves DINO score by 1.2 points over DreamBooth, establishing a new state of the art.