Daily Papers

Current volumetric biomedical foundation models struggle to generalize as public 3D datasets are small and do not cover the broad diversity of medical procedures, conditions, anatomical regions, and imaging protocols. We address this by creating a representation learning method that instead anticipates strong domain shifts at training time itself. We first propose a data engine that synthesizes highly variable training samples that would enable generalization to new biomedical contexts. To then train a single 3D network for any voxel-level task, we develop a contrastive learning method that pretrains the network to be stable against nuisance imaging variation simulated by the data engine, a key inductive bias for generalization. This network's features can be used as robust representations of input images for downstream tasks and its weights provide a strong, dataset-agnostic initialization for finetuning on new datasets. As a result, we set new standards across both multimodality registration and few-shot segmentation, a first for any 3D biomedical vision model, all without (pre-)training on any existing dataset of real images.

We propose an adaptive training scheme for unsupervised medical image registration. Existing methods rely on image reconstruction as the primary supervision signal. However, nuisance variables (e.g. noise and covisibility), violation of the Lambertian assumption in physical waves (e.g. ultrasound), and inconsistent image acquisition can all cause a loss of correspondence between medical images. As the unsupervised learning scheme relies on intensity constancy between images to establish correspondence for reconstruction, this introduces spurious error residuals that are not modeled by the typical training objective. To mitigate this, we propose an adaptive framework that re-weights the error residuals with a correspondence scoring map during training, preventing the parametric displacement estimator from drifting away due to noisy gradients, which leads to performance degradation. To illustrate the versatility and effectiveness of our method, we tested our framework on three representative registration architectures across three medical image datasets along with other baselines. Our adaptive framework consistently outperforms other methods both quantitatively and qualitatively. Paired t-tests show that our improvements are statistically significant. Code available at: https://voldemort108x.github.io/AdaCS/.

Spurious correlations allow flexible models to predict well during training but poorly on related test distributions. Recent work has shown that models that satisfy particular independencies involving correlation-inducing nuisance variables have guarantees on their test performance. Enforcing such independencies requires nuisances to be observed during training. However, nuisances, such as demographics or image background labels, are often missing. Enforcing independence on just the observed data does not imply independence on the entire population. Here we derive mmd estimators used for invariance objectives under missing nuisances. On simulations and clinical data, optimizing through these estimates achieves test performance similar to using estimators that make use of the full data.

Small sample sizes are common in many disciplines, which necessitates pooling roughly similar datasets across multiple institutions to study weak but relevant associations between images and disease outcomes. Such data often manifest shift/imbalance in covariates (i.e., secondary non-imaging data). Controlling for such nuisance variables is common within standard statistical analysis, but the ideas do not directly apply to overparameterized models. Consequently, recent work has shown how strategies from invariant representation learning provides a meaningful starting point, but the current repertoire of methods is limited to accounting for shifts/imbalances in just a couple of covariates at a time. In this paper, we show how viewing this problem from the perspective of Category theory provides a simple and effective solution that completely avoids elaborate multi-stage training pipelines that would otherwise be needed. We show the effectiveness of this approach via extensive experiments on real datasets. Further, we discuss how this style of formulation offers a unified perspective on at least 5+ distinct problem settings, from self-supervised learning to matching problems in 3D reconstruction.

Deep learning methods for unsupervised registration often rely on objectives that assume a uniform noise level across the spatial domain (e.g. mean-squared error loss), but noise distributions are often heteroscedastic and input-dependent in real-world medical images. Thus, this assumption often leads to degradation in registration performance, mainly due to the undesired influence of noise-induced outliers. To mitigate this, we propose a framework for heteroscedastic image uncertainty estimation that can adaptively reduce the influence of regions with high uncertainty during unsupervised registration. The framework consists of a collaborative training strategy for the displacement and variance estimators, and a novel image fidelity weighting scheme utilizing signal-to-noise ratios. Our approach prevents the model from being driven away by spurious gradients caused by the simplified homoscedastic assumption, leading to more accurate displacement estimation. To illustrate its versatility and effectiveness, we tested our framework on two representative registration architectures across three medical image datasets. Our method consistently outperforms baselines and produces sensible uncertainty estimates. The code is publicly available at https://voldemort108x.github.io/hetero_uncertainty/.

This paper focuses on the development of a space-variant regularization model for solving an under-determined linear inverse problem. The case study is a medical image reconstruction from few-view tomographic noisy data. The primary objective of the proposed optimization model is to achieve a good balance between denoising and the preservation of fine details and edges, overcoming the performance of the popular and largely used Total Variation (TV) regularization through the application of appropriate pixel-dependent weights. The proposed strategy leverages the role of gradient approximations for the computation of the space-variant TV weights. For this reason, a convolutional neural network is designed, to approximate both the ground truth image and its gradient using an elastic loss function in its training. Additionally, the paper provides a theoretical analysis of the proposed model, showing the uniqueness of its solution, and illustrates a Chambolle-Pock algorithm tailored to address the specific problem at hand. This comprehensive framework integrates innovative regularization techniques with advanced neural network capabilities, demonstrating promising results in achieving high-quality reconstructions from low-sampled tomographic data.

Most papers caution against using predictive models for disease stratification based on unselected radiomic features, as these features are affected by contouring variability. Instead, they advocate for the use of the Intraclass Correlation Coefficient (ICC) as a measure of stability for feature selection. However, the direct effect of segmentation variability on the predictive models is rarely studied. This study investigates the impact of segmentation variability on feature stability and predictive performance in radiomics-based prediction of Triple-Negative Breast Cancer (TNBC) subtype using Magnetic Resonance Imaging. A total of 244 images from the Duke dataset were used, with segmentation variability introduced through modifications of manual segmentations. For each mask, explainable radiomic features were selected using the Shapley Additive exPlanations method and used to train logistic regression models. Feature stability across segmentations was assessed via ICC, Pearson's correlation, and reliability scores quantifying the relationship between feature stability and segmentation variability. Results indicate that segmentation accuracy does not significantly impact predictive performance. While incorporating peritumoral information may reduce feature reproducibility, it does not diminish feature predictive capability. Moreover, feature selection in predictive models is not inherently tied to feature stability with respect to segmentation, suggesting that an overreliance on ICC or reliability scores for feature selection might exclude valuable predictive features.

Machine learning models for medical image analysis often suffer from poor performance on important subsets of a population that are not identified during training or testing. For example, overall performance of a cancer detection model may be high, but the model still consistently misses a rare but aggressive cancer subtype. We refer to this problem as hidden stratification, and observe that it results from incompletely describing the meaningful variation in a dataset. While hidden stratification can substantially reduce the clinical efficacy of machine learning models, its effects remain difficult to measure. In this work, we assess the utility of several possible techniques for measuring and describing hidden stratification effects, and characterize these effects on multiple medical imaging datasets. We find evidence that hidden stratification can occur in unidentified imaging subsets with low prevalence, low label quality, subtle distinguishing features, or spurious correlates, and that it can result in relative performance differences of over 20% on clinically important subsets. Finally, we explore the clinical implications of our findings, and suggest that evaluation of hidden stratification should be a critical component of any machine learning deployment in medical imaging.

An important challenge when using computer vision models in the real world is to evaluate their performance in potential out-of-distribution (OOD) scenarios. While simple synthetic corruptions are commonly applied to test OOD robustness, they often fail to capture nuisance shifts that occur in the real world. Recently, diffusion models have been applied to generate realistic images for benchmarking, but they are restricted to binary nuisance shifts. In this work, we introduce CNS-Bench, a Continuous Nuisance Shift Benchmark to quantify OOD robustness of image classifiers for continuous and realistic generative nuisance shifts. CNS-Bench allows generating a wide range of individual nuisance shifts in continuous severities by applying LoRA adapters to diffusion models. To address failure cases, we propose a filtering mechanism that outperforms previous methods, thereby enabling reliable benchmarking with generative models. With the proposed benchmark, we perform a large-scale study to evaluate the robustness of more than 40 classifiers under various nuisance shifts. Through carefully designed comparisons and analyses, we find that model rankings can change for varying shifts and shift scales, which cannot be captured when applying common binary shifts. Additionally, we show that evaluating the model performance on a continuous scale allows the identification of model failure points, providing a more nuanced understanding of model robustness. Project page including code and data: https://genintel.github.io/CNS.

Many low-dose CT imaging methods rely on supervised learning, which requires a large number of paired noisy and clean images. However, obtaining paired images in clinical practice is challenging. To address this issue, zero-shot self-supervised methods train denoising networks using only the information within a single image, such as ZS-N2N. However, these methods often employ downsampling operations that degrade image resolution. Additionally, the training dataset is inherently constrained to the image itself. In this paper, we propose a zero-shot low-dose CT imaging method based on sinogram flicking, which operates within a single image but generates many copies via random conjugate ray matching. Specifically, two conjugate X-ray pencil beams measure the same path; their expected values should be identical, while their noise levels vary during measurements. By randomly swapping portions of the conjugate X-rays in the sinogram domain, we generate a large set of sinograms with consistent content but varying noise patterns. When displayed dynamically, these sinograms exhibit a flickering effect due to their identical structural content but differing noise patterns-hence the term sinogram flicking. We train the network on pairs of sinograms with the same content but different noise distributions using a lightweight model adapted from ZS-NSN. This process is repeated to obtain the final results. A simulation study demonstrates that our method outperforms state-of-the-art approaches such as ZS-N2N.

Off-resonance artifacts in magnetic resonance imaging (MRI) are visual distortions that occur when the actual resonant frequencies of spins within the imaging volume differ from the expected frequencies used to encode spatial information. These discrepancies can be caused by a variety of factors, including magnetic field inhomogeneities, chemical shifts, or susceptibility differences within the tissues. Such artifacts can manifest as blurring, ghosting, or misregistration of the reconstructed image, and they often compromise its diagnostic quality. We propose to resolve these artifacts by lifting the 2D MRI reconstruction problem to 3D, introducing an additional "spectral" dimension to model this off-resonance. Our approach is inspired by recent progress in modeling radiance fields, and is capable of reconstructing both static and dynamic MR images as well as separating fat and water, which is of independent clinical interest. We demonstrate our approach in the context of PROPELLER (Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction) MRI acquisitions, which are popular for their robustness to motion artifacts. Our method operates in a few minutes on a single GPU, and to our knowledge is the first to correct for chemical shift in gradient echo PROPELLER MRI reconstruction without additional measurements or pretraining data.

Radiography imaging protocols focus on particular body regions, therefore producing images of great similarity and yielding recurrent anatomical structures across patients. To exploit this structured information, we propose the use of Space-aware Memory Queues for In-painting and Detecting anomalies from radiography images (abbreviated as SQUID). We show that SQUID can taxonomize the ingrained anatomical structures into recurrent patterns; and in the inference, it can identify anomalies (unseen/modified patterns) in the image. SQUID surpasses 13 state-of-the-art methods in unsupervised anomaly detection by at least 5 points on two chest X-ray benchmark datasets measured by the Area Under the Curve (AUC). Additionally, we have created a new dataset (DigitAnatomy), which synthesizes the spatial correlation and consistent shape in chest anatomy. We hope DigitAnatomy can prompt the development, evaluation, and interpretability of anomaly detection methods.

Medical Vision-Language Models (MVLMs) have achieved par excellence generalization in medical image analysis, yet their performance under noisy, corrupted conditions remains largely untested. Clinical imaging is inherently susceptible to acquisition artifacts and noise; however, existing evaluations predominantly assess generally clean datasets, overlooking robustness -- i.e., the model's ability to perform under real-world distortions. To address this gap, we first introduce MediMeta-C, a corruption benchmark that systematically applies several perturbations across multiple medical imaging datasets. Combined with MedMNIST-C, this establishes a comprehensive robustness evaluation framework for MVLMs. We further propose RobustMedCLIP, a visual encoder adaptation of a pretrained MVLM that incorporates few-shot tuning to enhance resilience against corruptions. Through extensive experiments, we benchmark 5 major MVLMs across 5 medical imaging modalities, revealing that existing models exhibit severe degradation under corruption and struggle with domain-modality tradeoffs. Our findings highlight the necessity of diverse training and robust adaptation strategies, demonstrating that efficient low-rank adaptation when paired with few-shot tuning, improves robustness while preserving generalization across modalities.

In the last decades, unsupervised deep learning based methods have caught researchers attention, since in many real applications, such as medical imaging, collecting a great amount of training examples is not always feasible. Moreover, the construction of a good training set is time consuming and hard because the selected data have to be enough representative for the task. In this paper, we focus on the Deep Image Prior (DIP) framework and we propose to combine it with a space-variant Total Variation regularizer with an automatic estimation of the local regularization parameters. Differently from other existing approaches, we solve the arising minimization problem via the flexible Alternating Direction Method of Multipliers (ADMM). Furthermore, we provide a specific implementation also for the standard isotropic Total Variation. The promising performances of the proposed approach, in terms of PSNR and SSIM values, are addressed through several experiments on simulated as well as real natural and medical corrupted images.

The integration of neural-network-based systems into clinical practice is limited by challenges related to domain generalization and robustness. The computer vision community established benchmarks such as ImageNet-C as a fundamental prerequisite to measure progress towards those challenges. Similar datasets are largely absent in the medical imaging community which lacks a comprehensive benchmark that spans across imaging modalities and applications. To address this gap, we create and open-source MedMNIST-C, a benchmark dataset based on the MedMNIST+ collection covering 12 datasets and 9 imaging modalities. We simulate task and modality-specific image corruptions of varying severity to comprehensively evaluate the robustness of established algorithms against real-world artifacts and distribution shifts. We further provide quantitative evidence that our simple-to-use artificial corruptions allow for highly performant, lightweight data augmentation to enhance model robustness. Unlike traditional, generic augmentation strategies, our approach leverages domain knowledge, exhibiting significantly higher robustness when compared to widely adopted methods. By introducing MedMNIST-C and open-sourcing the corresponding library allowing for targeted data augmentations, we contribute to the development of increasingly robust methods tailored to the challenges of medical imaging. The code is available at https://github.com/francescodisalvo05/medmnistc-api .

Convolutional Neural Networks have demonstrated dermatologist-level performance in the classification of melanoma from skin lesion images, but prediction irregularities due to biases seen within the training data are an issue that should be addressed before widespread deployment is possible. In this work, we robustly remove bias and spurious variation from an automated melanoma classification pipeline using two leading bias unlearning techniques. We show that the biases introduced by surgical markings and rulers presented in previous studies can be reasonably mitigated using these bias removal methods. We also demonstrate the generalisation benefits of unlearning spurious variation relating to the imaging instrument used to capture lesion images. Our experimental results provide evidence that the effects of each of the aforementioned biases are notably reduced, with different debiasing techniques excelling at different tasks.

Ensuring the quality and integrity of medical images is crucial for maintaining diagnostic accuracy in deep learning-based Computer-Aided Diagnosis and Computer-Aided Detection (CAD) systems. Covariate shifts are subtle variations in the data distribution caused by different imaging devices or settings and can severely degrade model performance, similar to the effects of adversarial attacks. Therefore, it is vital to have a lightweight and fast method to assess the quality of these images prior to using CAD models. AdverX-Ray addresses this need by serving as an image-quality assessment layer, designed to detect covariate shifts effectively. This Adversarial Variational Autoencoder prioritizes the discriminator's role, using the suboptimal outputs of the generator as negative samples to fine-tune the discriminator's ability to identify high-frequency artifacts. Images generated by adversarial networks often exhibit severe high-frequency artifacts, guiding the discriminator to focus excessively on these components. This makes the discriminator ideal for this approach. Trained on patches from X-ray images of specific machine models, AdverX-Ray can evaluate whether a scan matches the training distribution, or if a scan from the same machine is captured under different settings. Extensive comparisons with various OOD detection methods show that AdverX-Ray significantly outperforms existing techniques, achieving a 96.2% average AUROC using only 64 random patches from an X-ray. Its lightweight and fast architecture makes it suitable for real-time applications, enhancing the reliability of medical imaging systems. The code and pretrained models are publicly available.

Anomaly detection (AD) is essential for industrial inspection, yet existing methods typically rely on ``comparing'' test images to normal references from a training set. However, variations in appearance and positioning often complicate the alignment of these references with the test image, limiting detection accuracy. We observe that most anomalies manifest as local variations, meaning that even within anomalous images, valuable normal information remains. We argue that this information is useful and may be more aligned with the anomalies since both the anomalies and the normal information originate from the same image. Therefore, rather than relying on external normality from the training set, we propose INP-Former, a novel method that extracts Intrinsic Normal Prototypes (INPs) directly from the test image. Specifically, we introduce the INP Extractor, which linearly combines normal tokens to represent INPs. We further propose an INP Coherence Loss to ensure INPs can faithfully represent normality for the testing image. These INPs then guide the INP-Guided Decoder to reconstruct only normal tokens, with reconstruction errors serving as anomaly scores. Additionally, we propose a Soft Mining Loss to prioritize hard-to-optimize samples during training. INP-Former achieves state-of-the-art performance in single-class, multi-class, and few-shot AD tasks across MVTec-AD, VisA, and Real-IAD, positioning it as a versatile and universal solution for AD. Remarkably, INP-Former also demonstrates some zero-shot AD capability. Code is available at:https://github.com/luow23/INP-Former.

Recent work has investigated the distributions of learned convolution filters through a large-scale study containing hundreds of heterogeneous image models. Surprisingly, on average, the distributions only show minor drifts in comparisons of various studied dimensions including the learned task, image domain, or dataset. However, among the studied image domains, medical imaging models appeared to show significant outliers through "spikey" distributions, and, therefore, learn clusters of highly specific filters different from other domains. Following this observation, we study the collected medical imaging models in more detail. We show that instead of fundamental differences, the outliers are due to specific processing in some architectures. Quite the contrary, for standardized architectures, we find that models trained on medical data do not significantly differ in their filter distributions from similar architectures trained on data from other domains. Our conclusions reinforce previous hypotheses stating that pre-training of imaging models can be done with any kind of diverse image data.

Computed tomography (CT) serves as an effective tool for lung cancer screening, diagnosis, treatment, and prognosis, providing a rich source of features to quantify temporal and spatial tumor changes. Nonetheless, the diversity of CT scanners and customized acquisition protocols can introduce significant inconsistencies in texture features, even when assessing the same patient. This variability poses a fundamental challenge for subsequent research that relies on consistent image features. Existing CT image standardization models predominantly utilize GAN-based supervised or semi-supervised learning, but their performance remains limited. We present DiffusionCT, an innovative score-based DDPM model that operates in the latent space to transform disparate non-standard distributions into a standardized form. The architecture comprises a U-Net-based encoder-decoder, augmented by a DDPM model integrated at the bottleneck position. First, the encoder-decoder is trained independently, without embedding DDPM, to capture the latent representation of the input data. Second, the latent DDPM model is trained while keeping the encoder-decoder parameters fixed. Finally, the decoder uses the transformed latent representation to generate a standardized CT image, providing a more consistent basis for downstream analysis. Empirical tests on patient CT images indicate notable improvements in image standardization using DiffusionCT. Additionally, the model significantly reduces image noise in SPAD images, further validating the effectiveness of DiffusionCT for advanced imaging tasks.

Conditional normalizing flows can generate diverse image samples for solving inverse problems. Most normalizing flows for inverse problems in imaging employ the conditional affine coupling layer that can generate diverse images quickly. However, unintended severe artifacts are occasionally observed in the output of them. In this work, we address this critical issue by investigating the origins of these artifacts and proposing the conditions to avoid them. First of all, we empirically and theoretically reveal that these problems are caused by "exploding inverse" in the conditional affine coupling layer for certain out-of-distribution (OOD) conditional inputs. Then, we further validated that the probability of causing erroneous artifacts in pixels is highly correlated with a Mahalanobis distance-based OOD score for inverse problems in imaging. Lastly, based on our investigations, we propose a remark to avoid exploding inverse and then based on it, we suggest a simple remedy that substitutes the affine coupling layers with the modified rational quadratic spline coupling layers in normalizing flows, to encourage the robustness of generated image samples. Our experimental results demonstrated that our suggested methods effectively suppressed critical artifacts occurring in normalizing flows for super-resolution space generation and low-light image enhancement.

The purpose of this study is to present and compare three denoising diffusion probabilistic models (DDPMs) that generate 3D T_1-weighted MRI human brain images. Three DDPMs were trained using 80,675 image volumes from 42,406 subjects spanning 38 publicly available brain MRI datasets. These images had approximately 1 mm isotropic resolution and were manually inspected by three human experts to exclude those with poor quality, field-of-view issues, and excessive pathology. The images were minimally preprocessed to preserve the visual variability of the data. Furthermore, to enable the DDPMs to produce images with natural orientation variations and inhomogeneity, the images were neither registered to a common coordinate system nor bias field corrected. Evaluations included segmentation, Frechet Inception Distance (FID), and qualitative inspection. Regarding results, all three DDPMs generated coherent MR brain volumes. The velocity and flow prediction models achieved lower FIDs than the sample prediction model. However, all three models had higher FIDs compared to real images across multiple cohorts. In a permutation experiment, the generated brain regional volume distributions differed statistically from real data. However, the velocity and flow prediction models had fewer statistically different volume distributions in the thalamus and putamen. In conclusion this work presents and releases the first 3D non-latent diffusion model for brain data without skullstripping or registration. Despite the negative results in statistical testing, the presented DDPMs are capable of generating high-resolution 3D T_1-weighted brain images. All model weights and corresponding inference code are publicly available at https://github.com/piksl-research/medforj .

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.

Current methods for performing 3D reconstruction and novel view synthesis (NVS) in ultrasound imaging data often face severe artifacts when training NeRF-based approaches. The artifacts produced by current approaches differ from NeRF floaters in general scenes because of the unique nature of ultrasound capture. Furthermore, existing models fail to produce reasonable 3D reconstructions when ultrasound data is captured or obtained casually in uncontrolled environments, which is common in clinical settings. Consequently, existing reconstruction and NVS methods struggle to handle ultrasound motion, fail to capture intricate details, and cannot model transparent and reflective surfaces. In this work, we introduced NeRF-US, which incorporates 3D-geometry guidance for border probability and scattering density into NeRF training, while also utilizing ultrasound-specific rendering over traditional volume rendering. These 3D priors are learned through a diffusion model. Through experiments conducted on our new "Ultrasound in the Wild" dataset, we observed accurate, clinically plausible, artifact-free reconstructions.

Existing losses used in deep metric learning (DML) for image retrieval often lead to highly non-uniform intra-class and inter-class representation structures across test classes and data distributions. When combined with the common practice of using a fixed threshold to declare a match, this gives rise to significant performance variations in terms of false accept rate (FAR) and false reject rate (FRR) across test classes and data distributions. We define this issue in DML as threshold inconsistency. In real-world applications, such inconsistency often complicates the threshold selection process when deploying commercial image retrieval systems. To measure this inconsistency, we propose a novel variance-based metric called Operating-Point-Inconsistency-Score (OPIS) that quantifies the variance in the operating characteristics across classes. Using the OPIS metric, we find that achieving high accuracy levels in a DML model does not automatically guarantee threshold consistency. In fact, our investigation reveals a Pareto frontier in the high-accuracy regime, where existing methods to improve accuracy often lead to degradation in threshold consistency. To address this trade-off, we introduce the Threshold-Consistent Margin (TCM) loss, a simple yet effective regularization technique that promotes uniformity in representation structures across classes by selectively penalizing hard sample pairs. Extensive experiments demonstrate TCM's effectiveness in enhancing threshold consistency while preserving accuracy, simplifying the threshold selection process in practical DML settings.

This study presents the development of a spatially adaptive weighting strategy for Total Variation regularization, aimed at addressing under-determined linear inverse problems. The method leverages the rapid computation of an accurate approximation of the true image (or its gradient magnitude) through a neural network. Our approach operates without requiring prior knowledge of the noise intensity in the data and avoids the iterative recomputation of weights. Additionally, the paper includes a theoretical analysis of the proposed method, establishing its validity as a regularization approach. This framework integrates advanced neural network capabilities within a regularization context, thereby making the results of the networks interpretable. The results are promising as they enable high-quality reconstructions from limited-view tomographic measurements.

Masked autoencoders (MAEs) are increasingly applied to electronic health records (EHR) for learning general-purpose representations that support diverse clinical tasks. However, existing approaches typically rely on uniform random masking, implicitly assuming all features are equally predictable. In reality, laboratory tests exhibit substantial heterogeneity in volatility: some biomarkers (e.g., sodium) remain stable, while others (e.g., lactate) fluctuate considerably and are more difficult to model. Clinically, volatile biomarkers often signal acute pathophysiology and require more sophisticated modeling to capture their complex temporal patterns. We propose a volatility-aware pretraining strategy, Coefficient of Variation Masking (CV-Masking), that adaptively adjusts masking probabilities according to the intrinsic variability of each feature. Combined with a value-only masking objective aligned with clinical workflows, CV-Masking yields systematic improvements over random and variance-based strategies. Experiments on a large panel of laboratory tests show that CV-Masking enhances reconstruction, improves downstream predictive performance, and accelerates convergence, producing more robust and clinically meaningful EHR representations.

The PI-CAI (Prostate Imaging: Cancer AI) challenge led to expert-level diagnostic algorithms for clinically significant prostate cancer detection. The algorithms receive biparametric MRI scans as input, which consist of T2-weighted and diffusion-weighted scans. These scans can be misaligned due to multiple factors in the scanning process. Image registration can alleviate this issue by predicting the deformation between the sequences. We investigate the effect of image registration on the diagnostic performance of AI-based prostate cancer diagnosis. First, the image registration algorithm, developed in MeVisLab, is analyzed using a dataset with paired lesion annotations. Second, the effect on diagnosis is evaluated by comparing case-level cancer diagnosis performance between using the original dataset, rigidly aligned diffusion-weighted scans, or deformably aligned diffusion-weighted scans. Rigid registration showed no improvement. Deformable registration demonstrated a substantial improvement in lesion overlap (+10% median Dice score) and a positive yet non-significant improvement in diagnostic performance (+0.3% AUROC, p=0.18). Our investigation shows that a substantial improvement in lesion alignment does not directly lead to a significant improvement in diagnostic performance. Qualitative analysis indicated that jointly developing image registration methods and diagnostic AI algorithms could enhance diagnostic accuracy and patient outcomes.

Accurate prostate cancer diagnosis remains challenging. Even when using MRI, radiologists exhibit low specificity and significant inter-observer variability, leading to potential delays or inaccuracies in identifying clinically significant cancers. This leads to numerous unnecessary biopsies and risks of missing clinically significant cancers. Here we present prostate vision contrastive network (ProViCNet), prostate organ-specific vision foundation models for Magnetic Resonance Imaging (MRI) and Trans-Rectal Ultrasound imaging (TRUS) for comprehensive cancer detection. ProViCNet was trained and validated using 4,401 patients across six institutions, as a prostate cancer detection model on radiology images relying on patch-level contrastive learning guided by biopsy confirmed radiologist annotations. ProViCNet demonstrated consistent performance across multiple internal and external validation cohorts with area under the receiver operating curve values ranging from 0.875 to 0.966, significantly outperforming radiologists in the reader study (0.907 versus 0.805, p<0.001) for mpMRI, while achieving 0.670 to 0.740 for TRUS. We also integrated ProViCNet with standard PSA to develop a virtual screening test, and we showed that we can maintain the high sensitivity for detecting clinically significant cancers while more than doubling specificity from 15% to 38% (p<0.001), thereby substantially reducing unnecessary biopsies. These findings highlight that ProViCNet's potential for enhancing prostate cancer diagnosis accuracy and reduce unnecessary biopsies, thereby optimizing diagnostic pathways.

Motion artefacts in magnetic resonance brain images can have a strong impact on diagnostic confidence. The assessment of MR image quality is fundamental before proceeding with the clinical diagnosis. Motion artefacts can alter the delineation of structures such as the brain, lesions or tumours and may require a repeat scan. Otherwise, an inaccurate (e.g. correct pathology but wrong severity) or incorrect diagnosis (e.g. wrong pathology) may occur. "Image quality assessment" as a fast, automated step right after scanning can assist in deciding if the acquired images are diagnostically sufficient. An automated image quality assessment based on the structural similarity index (SSIM) regression through a residual neural network is proposed in this work. Additionally, a classification into different groups - by subdividing with SSIM ranges - is evaluated. Importantly, this method predicts SSIM values of an input image in the absence of a reference ground truth image. The networks were able to detect motion artefacts, and the best performance for the regression and classification task has always been achieved with ResNet-18 with contrast augmentation. The mean and standard deviation of residuals' distribution were mu=-0.0009 and sigma=0.0139, respectively. Whilst for the classification task in 3, 5 and 10 classes, the best accuracies were 97, 95 and 89\%, respectively. The results show that the proposed method could be a tool for supporting neuro-radiologists and radiographers in evaluating image quality quickly.

Determining whether two sets of images belong to the same or different distributions or domains is a crucial task in modern medical image analysis and deep learning; for example, to evaluate the output quality of image generative models. Currently, metrics used for this task either rely on the (potentially biased) choice of some downstream task, such as segmentation, or adopt task-independent perceptual metrics (e.g., Fréchet Inception Distance/FID) from natural imaging, which we show insufficiently capture anatomical features. To this end, we introduce a new perceptual metric tailored for medical images, FRD (Fréchet Radiomic Distance), which utilizes standardized, clinically meaningful, and interpretable image features. We show that FRD is superior to other image distribution metrics for a range of medical imaging applications, including out-of-domain (OOD) detection, the evaluation of image-to-image translation (by correlating more with downstream task performance as well as anatomical consistency and realism), and the evaluation of unconditional image generation. Moreover, FRD offers additional benefits such as stability and computational efficiency at low sample sizes, sensitivity to image corruptions and adversarial attacks, feature interpretability, and correlation with radiologist-perceived image quality. Additionally, we address key gaps in the literature by presenting an extensive framework for the multifaceted evaluation of image similarity metrics in medical imaging -- including the first large-scale comparative study of generative models for medical image translation -- and release an accessible codebase to facilitate future research. Our results are supported by thorough experiments spanning a variety of datasets, modalities, and downstream tasks, highlighting the broad potential of FRD for medical image analysis.

The development of larger models for medical image analysis has led to increased performance. However, it also affected our ability to explain and validate model decisions. Models can use non-relevant parts of images, also called spurious correlations or shortcuts, to obtain high performance on benchmark datasets but fail in real-world scenarios. In this work, we challenge the capacity of convolutional neural networks (CNN) to classify chest X-rays and eye fundus images while masking out clinically relevant parts of the image. We show that all models trained on the PadChest dataset, irrespective of the masking strategy, are able to obtain an Area Under the Curve (AUC) above random. Moreover, the models trained on full images obtain good performance on images without the region of interest (ROI), even superior to the one obtained on images only containing the ROI. We also reveal a possible spurious correlation in the Chaksu dataset while the performances are more aligned with the expectation of an unbiased model. We go beyond the performance analysis with the usage of the explainability method SHAP and the analysis of embeddings. We asked a radiology resident to interpret chest X-rays under different masking to complement our findings with clinical knowledge. Our code is available at https://github.com/TheoSourget/MMC_Masking and https://github.com/TheoSourget/MMC_Masking_EyeFundus

Diffusion-based image super-resolution methods have demonstrated significant advantages over GAN-based approaches, particularly in terms of perceptual quality. Building upon a lengthy Markov chain, diffusion-based methods possess remarkable modeling capacity, enabling them to achieve outstanding performance in real-world scenarios. Unlike previous methods that focus on modifying the noise schedule or sampling process to enhance performance, our approach emphasizes the improved utilization of LR information. We find that different regions of the LR image can be viewed as corresponding to different timesteps in a diffusion process, where flat areas are closer to the target HR distribution but edge and texture regions are farther away. In these flat areas, applying a slight noise is more advantageous for the reconstruction. We associate this characteristic with uncertainty and propose to apply uncertainty estimate to guide region-specific noise level control, a technique we refer to as Uncertainty-guided Noise Weighting. Pixels with lower uncertainty (i.e., flat regions) receive reduced noise to preserve more LR information, therefore improving performance. Furthermore, we modify the network architecture of previous methods to develop our Uncertainty-guided Perturbation Super-Resolution (UPSR) model. Extensive experimental results demonstrate that, despite reduced model size and training overhead, the proposed UWSR method outperforms current state-of-the-art methods across various datasets, both quantitatively and qualitatively.

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.

Image registration is fundamental in medical imaging, enabling precise alignment of anatomical structures for diagnosis, treatment planning, image-guided treatment or longitudinal monitoring. This work introduces IMPACT (Image Metric with Pretrained model-Agnostic Comparison for Transmodality registration), a generic semantic similarity metric designed for seamless integration into diverse image registration frameworks (such as Elastix and Voxelmorph). It compares deep learning-based features extracted from medical images without requiring task-specific training, ensuring broad applicability across various modalities. By leveraging the features of the large-scale pretrained TotalSegmentator models and the ability to integrate Segment Anything Model (SAM) and other large-scale segmentation networks, this approach offers significant advantages. It provides robust, scalable, and efficient solutions for multimodal image registration. The IMPACT loss was evaluated on five challenging registration tasks involving thoracic CT/CBCT, and pelvic MR/CT datasets. Quantitative metrics, such as Target Registration Error and Dice Similarity Coefficient, demonstrated significant improvements in anatomical alignment compared to baseline methods. Qualitative analyses further confirmed the increased robustness of the proposed metric in the face of noise, artifacts, and modality variations. IMPACT's versatility and efficiency make it a valuable tool for advancing registration performance in clinical and research applications, addressing critical challenges in multimodal medical imaging.

Achieving robust performance and fairness across diverse patient populations remains a challenge in developing clinically deployable deep learning models for diagnostic imaging. Synthetic data generation has emerged as a promising strategy to address limitations in dataset scale and diversity. We introduce RoentGen-v2, a text-to-image diffusion model for chest radiographs that enables fine-grained control over both radiographic findings and patient demographic attributes, including sex, age, and race/ethnicity. RoentGen-v2 is the first model to generate clinically plausible images with demographic conditioning, facilitating the creation of a large, demographically balanced synthetic dataset comprising over 565,000 images. We use this large synthetic dataset to evaluate optimal training pipelines for downstream disease classification models. In contrast to prior work that combines real and synthetic data naively, we propose an improved training strategy that leverages synthetic data for supervised pretraining, followed by fine-tuning on real data. Through extensive evaluation on over 137,000 chest radiographs from five institutions, we demonstrate that synthetic pretraining consistently improves model performance, generalization to out-of-distribution settings, and fairness across demographic subgroups. Across datasets, synthetic pretraining led to a 6.5% accuracy increase in the performance of downstream classification models, compared to a modest 2.7% increase when naively combining real and synthetic data. We observe this performance improvement simultaneously with the reduction of the underdiagnosis fairness gap by 19.3%. These results highlight the potential of synthetic imaging to advance equitable and generalizable medical deep learning under real-world data constraints. We open source our code, trained models, and synthetic dataset at https://github.com/StanfordMIMI/RoentGen-v2 .

Biomedical imaging datasets are often small and biased, meaning that real-world performance of predictive models can be substantially lower than expected from internal testing. This work proposes using generative image editing to simulate dataset shifts and diagnose failure modes of biomedical vision models; this can be used in advance of deployment to assess readiness, potentially reducing cost and patient harm. Existing editing methods can produce undesirable changes, with spurious correlations learned due to the co-occurrence of disease and treatment interventions, limiting practical applicability. To address this, we train a text-to-image diffusion model on multiple chest X-ray datasets and introduce a new editing method RadEdit that uses multiple masks, if present, to constrain changes and ensure consistency in the edited images. We consider three types of dataset shifts: acquisition shift, manifestation shift, and population shift, and demonstrate that our approach can diagnose failures and quantify model robustness without additional data collection, complementing more qualitative tools for explainable AI.

Although deep learning (DL) has received much attention in accelerated magnetic resonance imaging (MRI), recent studies show that tiny input perturbations may lead to instabilities of DL-based MRI reconstruction models. However, the approaches of robustifying these models are underdeveloped. Compared to image classification, it could be much more challenging to achieve a robust MRI image reconstruction network considering its regression-based learning objective, limited amount of training data, and lack of efficient robustness metrics. To circumvent the above limitations, our work revisits the problem of DL-based image reconstruction through the lens of robust machine learning. We find a new instability source of MRI image reconstruction, i.e., the lack of reconstruction robustness against spatial transformations of an input, e.g., rotation and cutout. Inspired by this new robustness metric, we develop a robustness-aware image reconstruction method that can defend against both pixel-wise adversarial perturbations as well as spatial transformations. Extensive experiments are also conducted to demonstrate the effectiveness of our proposed approaches.

Despite the remarkable success, recent reconstruction-based anomaly detection (AD) methods via diffusion modeling still involve fine-grained noise-strength tuning and computationally expensive multi-step denoising, leading to a fundamental tension between fidelity and efficiency. In this paper, we propose InvAD, a novel inversion-based anomaly detection approach ("detection via noising in latent space") that circumvents explicit reconstruction. Importantly, we contend that the limitations in prior reconstruction-based methods originate from the prevailing "detection via denoising in RGB space" paradigm. To address this, we model AD under a reconstruction-free formulation, which directly infers the final latent variable corresponding to the input image via DDIM inversion, and then measures the deviation based on the known prior distribution for anomaly scoring. Specifically, in approximating the original probability flow ODE using the Euler method, we enforce only a few inversion steps to noise the clean image to pursue inference efficiency. As the added noise is adaptively derived with the learned diffusion model, the original features for the clean testing image can still be leveraged to yield high detection accuracy. We perform extensive experiments and detailed analyses across four widely used industrial and medical AD benchmarks under the unsupervised unified setting to demonstrate the effectiveness of our model, achieving state-of-the-art AD performance and approximately 2x inference-time speedup without diffusion distillation.

Visual anomaly detection aims to identify anomalous regions in images through unsupervised learning paradigms, with increasing application demand and value in fields such as industrial inspection and medical lesion detection. Despite significant progress in recent years, there is a lack of comprehensive benchmarks to adequately evaluate the performance of various mainstream methods across different datasets under the practical multi-class setting. The absence of standardized experimental setups can lead to potential biases in training epochs, resolution, and metric results, resulting in erroneous conclusions. This paper addresses this issue by proposing a comprehensive visual anomaly detection benchmark, ADer, which is a modular framework that is highly extensible for new methods. The benchmark includes multiple datasets from industrial and medical domains, implementing fifteen state-of-the-art methods and nine comprehensive metrics. Additionally, we have proposed the GPU-assisted ADEval package to address the slow evaluation problem of metrics like time-consuming mAU-PRO on large-scale data, significantly reducing evaluation time by more than 1000-fold. Through extensive experimental results, we objectively reveal the strengths and weaknesses of different methods and provide insights into the challenges and future directions of multi-class visual anomaly detection. We hope that ADer will become a valuable resource for researchers and practitioners in the field, promoting the development of more robust and generalizable anomaly detection systems. Full codes are open-sourced at https://github.com/zhangzjn/ader.

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.

Existing denoising generative models rely on solving discretized reverse-time SDEs or ODEs. In this paper, we identify a long-overlooked yet pervasive issue in this family of models: a misalignment between the pre-defined noise level and the actual noise level encoded in intermediate states during sampling. We refer to this misalignment as noise shift. Through empirical analysis, we demonstrate that noise shift is widespread in modern diffusion models and exhibits a systematic bias, leading to sub-optimal generation due to both out-of-distribution generalization and inaccurate denoising updates. To address this problem, we propose Noise Awareness Guidance (NAG), a simple yet effective correction method that explicitly steers sampling trajectories to remain consistent with the pre-defined noise schedule. We further introduce a classifier-free variant of NAG, which jointly trains a noise-conditional and a noise-unconditional model via noise-condition dropout, thereby eliminating the need for external classifiers. Extensive experiments, including ImageNet generation and various supervised fine-tuning tasks, show that NAG consistently mitigates noise shift and substantially improves the generation quality of mainstream diffusion models.

Despite the remarkable progress in generative modelling, current diffusion models lack a quantitative approach to assess image quality. To address this limitation, we propose to estimate the pixel-wise aleatoric uncertainty during the sampling phase of diffusion models and utilise the uncertainty to improve the sample generation quality. The uncertainty is computed as the variance of the denoising scores with a perturbation scheme that is specifically designed for diffusion models. We then show that the aleatoric uncertainty estimates are related to the second-order derivative of the diffusion noise distribution. We evaluate our uncertainty estimation algorithm and the uncertainty-guided sampling on the ImageNet and CIFAR-10 datasets. In our comparisons with the related work, we demonstrate promising results in filtering out low quality samples. Furthermore, we show that our guided approach leads to better sample generation in terms of FID scores.

Detecting out-of-distribution (OOD) samples in medical imaging plays an important role for downstream medical diagnosis. However, existing OOD detectors are demonstrated on natural images composed of inter-classes and have difficulty generalizing to medical images. The key issue is the granularity of OOD data in the medical domain, where intra-class OOD samples are predominant. We focus on the generalizability of OOD detection for medical images and propose a self-supervised Cascade Variational autoencoder-based Anomaly Detector (CVAD). We use a variational autoencoders' cascade architecture, which combines latent representation at multiple scales, before being fed to a discriminator to distinguish the OOD data from the in-distribution (ID) data. Finally, both the reconstruction error and the OOD probability predicted by the binary discriminator are used to determine the anomalies. We compare the performance with the state-of-the-art deep learning models to demonstrate our model's efficacy on various open-access medical imaging datasets for both intra- and inter-class OOD. Further extensive results on datasets including common natural datasets show our model's effectiveness and generalizability. The code is available at https://github.com/XiaoyuanGuo/CVAD.

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.

It is well known that many open-released foundational diffusion models have difficulty in generating images that substantially depart from average brightness, despite such images being present in the training data. This is due to an inconsistency: while denoising starts from pure Gaussian noise during inference, the training noise schedule retains residual data even in the final timestep distribution, due to difficulties in numerical conditioning in mainstream formulation, leading to unintended bias during inference. To mitigate this issue, certain epsilon-prediction models are combined with an ad-hoc offset-noise methodology. In parallel, some contemporary models have adopted zero-terminal SNR noise schedules together with v-prediction, which necessitate major alterations to pre-trained models. However, such changes risk destabilizing a large multitude of community-driven applications anchored on these pre-trained models. In light of this, our investigation revisits the fundamental causes, leading to our proposal of an innovative and principled remedy, called One More Step (OMS). By integrating a compact network and incorporating an additional simple yet effective step during inference, OMS elevates image fidelity and harmonizes the dichotomy between training and inference, while preserving original model parameters. Once trained, various pre-trained diffusion models with the same latent domain can share the same OMS module.

Anomaly detection (AD) aims at detecting abnormal samples that deviate from the expected normal patterns. Generally, it can be trained merely on normal data, without a requirement for abnormal samples, and thereby plays an important role in rare disease recognition and health screening in the medical domain. Despite the emergence of numerous methods for medical AD, the lack of a fair and comprehensive evaluation causes ambiguous conclusions and hinders the development of this field. To address this problem, this paper builds a benchmark with unified comparison. Seven medical datasets with five image modalities, including chest X-rays, brain MRIs, retinal fundus images, dermatoscopic images, and histopathology images, are curated for extensive evaluation. Thirty typical AD methods, including reconstruction and self-supervised learning-based methods, are involved in comparison of image-level anomaly classification and pixel-level anomaly segmentation. Furthermore, for the first time, we systematically investigate the effect of key components in existing methods, revealing unresolved challenges and potential future directions. The datasets and code are available at https://github.com/caiyu6666/MedIAnomaly.

Echocardiography has been a prominent tool for the diagnosis of cardiac disease. However, these diagnoses can be heavily impeded by poor image quality. Acoustic clutter emerges due to multipath reflections imposed by layers of skin, subcutaneous fat, and intercostal muscle between the transducer and heart. As a result, haze and other noise artifacts pose a real challenge to cardiac ultrasound imaging. In many cases, especially with difficult-to-image patients such as patients with obesity, a diagnosis from B-Mode ultrasound imaging is effectively rendered unusable, forcing sonographers to resort to contrast-enhanced ultrasound examinations or refer patients to other imaging modalities. Tissue harmonic imaging has been a popular approach to combat haze, but in severe cases is still heavily impacted by haze. Alternatively, denoising algorithms are typically unable to remove highly structured and correlated noise, such as haze. It remains a challenge to accurately describe the statistical properties of structured haze, and develop an inference method to subsequently remove it. Diffusion models have emerged as powerful generative models and have shown their effectiveness in a variety of inverse problems. In this work, we present a joint posterior sampling framework that combines two separate diffusion models to model the distribution of both clean ultrasound and haze in an unsupervised manner. Furthermore, we demonstrate techniques for effectively training diffusion models on radio-frequency ultrasound data and highlight the advantages over image data. Experiments on both in-vitro and in-vivo cardiac datasets show that the proposed dehazing method effectively removes haze while preserving signals from weakly reflected tissue.

Lung diseases represent a significant global health challenge, with Chest X-Ray (CXR) being a key diagnostic tool due to their accessibility and affordability. Nonetheless, the detection of pulmonary lesions is often hindered by overlapping bone structures in CXR images, leading to potential misdiagnoses. To address this issue, we developed an end-to-end framework called BS-LDM, designed to effectively suppress bone in high-resolution CXR images. This framework is based on conditional latent diffusion models and incorporates a multi-level hybrid loss-constrained vector-quantized generative adversarial network which is crafted for perceptual compression, ensuring the preservation of details. To further enhance the framework's performance, we introduce offset noise and a temporal adaptive thresholding strategy. These additions help minimize discrepancies in generating low-frequency information, thereby improving the clarity of the generated soft tissue images. Additionally, we have compiled a high-quality bone suppression dataset named SZCH-X-Rays. This dataset includes 818 pairs of high-resolution CXR and dual-energy subtraction soft tissue images collected from a partner hospital. Moreover, we processed 241 data pairs from the JSRT dataset into negative images, which are more commonly used in clinical practice. Our comprehensive experimental and clinical evaluations reveal that BS-LDM excels in bone suppression, underscoring its significant clinical value.

Effective denoising is crucial in low-dose CT to enhance subtle structures and low-contrast lesions while preventing diagnostic errors. Supervised methods struggle with limited paired datasets, and self-supervised approaches often require multiple noisy images and rely on deep networks like U-Net, offering little insight into the denoising mechanism. To address these challenges, we propose an interpretable self-supervised single-image denoising framework -- Filter2Noise (F2N). Our approach introduces an Attention-Guided Bilateral Filter that adapted to each noisy input through a lightweight module that predicts spatially varying filter parameters, which can be visualized and adjusted post-training for user-controlled denoising in specific regions of interest. To enable single-image training, we introduce a novel downsampling shuffle strategy with a new self-supervised loss function that extends the concept of Noise2Noise to a single image and addresses spatially correlated noise. On the Mayo Clinic 2016 low-dose CT dataset, F2N outperforms the leading self-supervised single-image method (ZS-N2N) by 4.59 dB PSNR while improving transparency, user control, and parametric efficiency. These features provide key advantages for medical applications that require precise and interpretable noise reduction. Our code is demonstrated at https://github.com/sypsyp97/Filter2Noise.git .

Numerous diffusion models have recently been applied to image synthesis and editing. However, editing 3D scenes is still in its early stages. It poses various challenges, such as the requirement to design specific methods for different editing types, retraining new models for various 3D scenes, and the absence of convenient human interaction during editing. To tackle these issues, we introduce a text-driven editing method, termed DN2N, which allows for the direct acquisition of a NeRF model with universal editing capabilities, eliminating the requirement for retraining. Our method employs off-the-shelf text-based editing models of 2D images to modify the 3D scene images, followed by a filtering process to discard poorly edited images that disrupt 3D consistency. We then consider the remaining inconsistency as a problem of removing noise perturbation, which can be solved by generating training data with similar perturbation characteristics for training. We further propose cross-view regularization terms to help the generalized NeRF model mitigate these perturbations. Our text-driven method allows users to edit a 3D scene with their desired description, which is more friendly, intuitive, and practical than prior works. Empirical results show that our method achieves multiple editing types, including but not limited to appearance editing, weather transition, material changing, and style transfer. Most importantly, our method generalizes well with editing abilities shared among a set of model parameters without requiring a customized editing model for some specific scenes, thus inferring novel views with editing effects directly from user input. The project website is available at https://sk-fun.fun/DN2N

Background: Thyroid ultrasound is commonly performed using a combination of static images and cine clips (video recordings). However, the exact utility and impact of cine images remains unknown. This study aimed to evaluate the impact of cine imaging on accuracy and consistency of thyroid nodule assessment, using the American College of Radiology Thyroid Reporting and Data System (ACR TI-RADS). Methods: 50 benign and 50 malignant thyroid nodules with cytopathology results were included. A reader study with 4 specialty-trained radiologists was then conducted over 3 rounds, assessing only static images in the first two rounds and both static and cine images in the third round. TI-RADS scores and the consequent management recommendations were then evaluated by comparing them to the malignancy status of the nodules. Results: Mean sensitivity for malignancy detection was 0.65 for static images and 0.67 with both static and cine images (p>0.5). Specificity was 0.20 for static images and 0.22 with both static and cine images (p>0.5). Management recommendations were similar with and without cine images. Intrareader agreement on feature assignments remained consistent across all rounds, though TI-RADS point totals were slightly higher with cine images. Conclusion: The inclusion of cine imaging for thyroid nodule assessment on ultrasound did not significantly change diagnostic performance. Current practice guidelines, which do not mandate cine imaging, are sufficient for accurate diagnosis.

While recent advancing image super-resolution (SR) techniques are continually improving the perceptual quality of their outputs, they can usually fail in quantitative evaluations. This inconsistency leads to a growing distrust in existing image metrics for SR evaluations. Though image evaluation depends on both the metric and the reference ground truth (GT), researchers typically do not inspect the role of GTs, as they are generally accepted as `perfect' references. However, due to the data being collected in the early years and the ignorance of controlling other types of distortions, we point out that GTs in existing SR datasets can exhibit relatively poor quality, which leads to biased evaluations. Following this observation, in this paper, we are interested in the following questions: Are GT images in existing SR datasets 100% trustworthy for model evaluations? How does GT quality affect this evaluation? And how to make fair evaluations if there exist imperfect GTs? To answer these questions, this paper presents two main contributions. First, by systematically analyzing seven state-of-the-art SR models across three real-world SR datasets, we show that SR performances can be consistently affected across models by low-quality GTs, and models can perform quite differently when GT quality is controlled. Second, we propose a novel perceptual quality metric, Relative Quality Index (RQI), that measures the relative quality discrepancy of image pairs, thus issuing the biased evaluations caused by unreliable GTs. Our proposed model achieves significantly better consistency with human opinions. We expect our work to provide insights for the SR community on how future datasets, models, and metrics should be developed.

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.

Diffusion models have opened the path to a wide range of text-based image editing frameworks. However, these typically build on the multi-step nature of the diffusion backwards process, and adapting them to distilled, fast-sampling methods has proven surprisingly challenging. Here, we focus on a popular line of text-based editing frameworks - the ``edit-friendly'' DDPM-noise inversion approach. We analyze its application to fast sampling methods and categorize its failures into two classes: the appearance of visual artifacts, and insufficient editing strength. We trace the artifacts to mismatched noise statistics between inverted noises and the expected noise schedule, and suggest a shifted noise schedule which corrects for this offset. To increase editing strength, we propose a pseudo-guidance approach that efficiently increases the magnitude of edits without introducing new artifacts. All in all, our method enables text-based image editing with as few as three diffusion steps, while providing novel insights into the mechanisms behind popular text-based editing approaches.

Automated radiology report generation offers an effective solution to alleviate radiologists' workload. However, most existing methods focus primarily on single or fixed-view images to model current disease conditions, which limits diagnostic accuracy and overlooks disease progression. Although some approaches utilize longitudinal data to track disease progression, they still rely on single images to analyze current visits. To address these issues, we propose enhanced contrastive learning with Multi-view Longitudinal data to facilitate chest X-ray Report Generation, named MLRG. Specifically, we introduce a multi-view longitudinal contrastive learning method that integrates spatial information from current multi-view images and temporal information from longitudinal data. This method also utilizes the inherent spatiotemporal information of radiology reports to supervise the pre-training of visual and textual representations. Subsequently, we present a tokenized absence encoding technique to flexibly handle missing patient-specific prior knowledge, allowing the model to produce more accurate radiology reports based on available prior knowledge. Extensive experiments on MIMIC-CXR, MIMIC-ABN, and Two-view CXR datasets demonstrate that our MLRG outperforms recent state-of-the-art methods, achieving a 2.3% BLEU-4 improvement on MIMIC-CXR, a 5.5% F1 score improvement on MIMIC-ABN, and a 2.7% F1 RadGraph improvement on Two-view CXR.

We empirically study the effect of noise scheduling strategies for denoising diffusion generative models. There are three findings: (1) the noise scheduling is crucial for the performance, and the optimal one depends on the task (e.g., image sizes), (2) when increasing the image size, the optimal noise scheduling shifts towards a noisier one (due to increased redundancy in pixels), and (3) simply scaling the input data by a factor of b while keeping the noise schedule function fixed (equivalent to shifting the logSNR by log b) is a good strategy across image sizes. This simple recipe, when combined with recently proposed Recurrent Interface Network (RIN), yields state-of-the-art pixel-based diffusion models for high-resolution images on ImageNet, enabling single-stage, end-to-end generation of diverse and high-fidelity images at 1024times1024 resolution (without upsampling/cascades).

This paper investigates discrepancies in how neural networks learn from different imaging domains, which are commonly overlooked when adopting computer vision techniques from the domain of natural images to other specialized domains such as medical images. Recent works have found that the generalization error of a trained network typically increases with the intrinsic dimension (d_{data}) of its training set. Yet, the steepness of this relationship varies significantly between medical (radiological) and natural imaging domains, with no existing theoretical explanation. We address this gap in knowledge by establishing and empirically validating a generalization scaling law with respect to d_{data}, and propose that the substantial scaling discrepancy between the two considered domains may be at least partially attributed to the higher intrinsic ``label sharpness'' (K_F) of medical imaging datasets, a metric which we propose. Next, we demonstrate an additional benefit of measuring the label sharpness of a training set: it is negatively correlated with the trained model's adversarial robustness, which notably leads to models for medical images having a substantially higher vulnerability to adversarial attack. Finally, we extend our d_{data} formalism to the related metric of learned representation intrinsic dimension (d_{repr}), derive a generalization scaling law with respect to d_{repr}, and show that d_{data} serves as an upper bound for d_{repr}. Our theoretical results are supported by thorough experiments with six models and eleven natural and medical imaging datasets over a range of training set sizes. Our findings offer insights into the influence of intrinsic dataset properties on generalization, representation learning, and robustness in deep neural networks. Code link: https://github.com/mazurowski-lab/intrinsic-properties

Medical image registration is a critical task that estimates the spatial correspondence between pairs of images. However, current traditional and deep-learning-based methods rely on similarity measures to generate a deforming field, which often results in disproportionate volume changes in dissimilar regions, especially in tumor regions. These changes can significantly alter the tumor size and underlying anatomy, which limits the practical use of image registration in clinical diagnosis. To address this issue, we have formulated image registration with tumors as a constraint problem that preserves tumor volumes while maximizing image similarity in other normal regions. Our proposed strategy involves a two-stage process. In the first stage, we use similarity-based registration to identify potential tumor regions by their volume change, generating a soft tumor mask accordingly. In the second stage, we propose a volume-preserving registration with a novel adaptive volume-preserving loss that penalizes the change in size adaptively based on the masks calculated from the previous stage. Our approach balances image similarity and volume preservation in different regions, i.e., normal and tumor regions, by using soft tumor masks to adjust the imposition of volume-preserving loss on each one. This ensures that the tumor volume is preserved during the registration process. We have evaluated our strategy on various datasets and network architectures, demonstrating that our method successfully preserves the tumor volume while achieving comparable registration results with state-of-the-art methods. Our codes is available at: https://dddraxxx.github.io/Volume-Preserving-Registration/.

Text-guided diffusion models have significantly advanced image editing, enabling high-quality and diverse modifications driven by text prompts. However, effective editing requires inverting the source image into a latent space, a process often hindered by prediction errors inherent in DDIM inversion. These errors accumulate during the diffusion process, resulting in inferior content preservation and edit fidelity, especially with conditional inputs. We address these challenges by investigating the primary contributors to error accumulation in DDIM inversion and identify the singularity problem in traditional noise schedules as a key issue. To resolve this, we introduce the Logistic Schedule, a novel noise schedule designed to eliminate singularities, improve inversion stability, and provide a better noise space for image editing. This schedule reduces noise prediction errors, enabling more faithful editing that preserves the original content of the source image. Our approach requires no additional retraining and is compatible with various existing editing methods. Experiments across eight editing tasks demonstrate the Logistic Schedule's superior performance in content preservation and edit fidelity compared to traditional noise schedules, highlighting its adaptability and effectiveness.

Artifacts are a common occurrence in Diffusion MRI (dMRI) scans. Identifying and removing them is essential to ensure the accuracy and viability of any post processing carried out on these scans. This makes QC (quality control) a crucial first step prior to any analysis of dMRI data. Several QC methods for artifact detection exist, however they suffer from problems like requiring manual intervention and the inability to generalize across different artifacts and datasets. In this paper, we propose an automated deep learning (DL) pipeline that utilizes a 3D-Densenet architecture to train a model on diffusion volumes for automatic artifact detection. Our method is applied on a vast dataset consisting of 9000 volumes sourced from 7 large clinical datasets. These datasets comprise scans from multiple scanners with different gradient directions, high and low b values, single shell and multi shell acquisitions. Additionally, they represent diverse subject demographics like the presence or absence of pathologies. Our QC method is found to accurately generalize across this heterogenous data by correctly detecting 92% artifacts on average across our test set. This consistent performance over diverse datasets underlines the generalizability of our method, which currently is a significant barrier hindering the widespread adoption of automated QC techniques. For these reasons, we believe that 3D-QCNet can be integrated in diffusion pipelines to effectively automate the arduous and time-intensive process of artifact detection.

Pre-training on large-scale datasets and then fine-tuning on downstream tasks have become a standard practice in deep learning. However, pre-training data often contain label noise that may adversely affect the generalization of the model. This paper aims to understand the nature of noise in pre-training datasets and to mitigate its impact on downstream tasks. More specifically, through extensive experiments of supervised pre-training models on synthetic noisy ImageNet-1K and YFCC15M datasets, we demonstrate that while slight noise in pre-training can benefit in-domain (ID) transfer performance, where the training and testing data share the same distribution, it always deteriorates out-of-domain (OOD) performance, where training and testing data distribution are different. We empirically verify that the reason behind is noise in pre-training shapes the feature space differently. We then propose a light-weight black-box tuning method (NMTune) to affine the feature space to mitigate the malignant effect of noise and improve generalization on both ID and OOD tasks, considering one may not be able to fully fine-tune or even access the pre-trained models. We conduct practical experiments on popular vision and language models that are pre-trained on noisy data for evaluation of our approach. Our analysis and results show the importance of this interesting and novel research direction, which we term Noisy Model Learning.

Ultrasound (US) is one of the most widely used medical imaging modalities, thanks to its low cost, portability, real-time feedback, and absence of ionizing radiation. However, US image interpretation remains highly operator-dependent and varies significantly across anatomical regions, acquisition protocols, and device types. These variations, along with unique challenges such as speckle, low contrast, and limited standardized annotations, hinder the development of generalizable, label-efficient ultrasound AI models. In this paper, we propose OpenUS, the first reproducible, open-source ultrasound foundation model built on a large collection of public data. OpenUS employs a vision Mamba backbone, capturing both local and global long-range dependencies across the image. To extract rich features during pre-training, we introduce a novel self-adaptive masking framework that combines contrastive learning with masked image modeling. This strategy integrates the teacher's attention map with student reconstruction loss, adaptively refining clinically-relevant masking to enhance pre-training effectiveness. OpenUS also applies a dynamic learning schedule to progressively adjust the difficulty of the pre-training process. To develop the foundation model, we compile the largest to-date public ultrasound dataset comprising over 308K images from 42 publicly available datasets, covering diverse anatomical regions, institutions, imaging devices, and disease types. Our pre-trained OpenUS model can be easily adapted to specific downstream tasks by serving as a backbone for label-efficient fine-tuning. Code is available at https://github.com/XZheng0427/OpenUS.

Text-to-image diffusion models trained on a fixed set of resolutions often fail to generalize, even when asked to generate images at lower resolutions than those seen during training. High-resolution text-to-image generators are currently unable to easily offer an out-of-the-box budget-efficient alternative to their users who might not need high-resolution images. We identify a key technical insight in diffusion models that when addressed can help tackle this limitation: Noise schedulers have unequal perceptual effects across resolutions. The same level of noise removes disproportionately more signal from lower-resolution images than from high-resolution images, leading to a train-test mismatch. We propose NoiseShift, a training-free method that recalibrates the noise level of the denoiser conditioned on resolution size. NoiseShift requires no changes to model architecture or sampling schedule and is compatible with existing models. When applied to Stable Diffusion 3, Stable Diffusion 3.5, and Flux-Dev, quality at low resolutions is significantly improved. On LAION-COCO, NoiseShift improves SD3.5 by 15.89%, SD3 by 8.56%, and Flux-Dev by 2.44% in FID on average. On CelebA, NoiseShift improves SD3.5 by 10.36%, SD3 by 5.19%, and Flux-Dev by 3.02% in FID on average. These results demonstrate the effectiveness of NoiseShift in mitigating resolution-dependent artifacts and enhancing the quality of low-resolution image generation.

Chest X-rays (CXRs) are commonly utilized as a low-dose modality for lung screening. Nonetheless, the efficacy of CXRs is somewhat impeded, given that approximately 75% of the lung area overlaps with bone, which in turn hampers the detection and diagnosis of diseases. As a remedial measure, bone suppression techniques have been introduced. The current dual-energy subtraction imaging technique in the clinic requires costly equipment and subjects being exposed to high radiation. To circumvent these issues, deep learning-based image generation algorithms have been proposed. However, existing methods fall short in terms of producing high-quality images and capturing texture details, particularly with pulmonary vessels. To address these issues, this paper proposes a new bone suppression framework, termed BS-Diff, that comprises a conditional diffusion model equipped with a U-Net architecture and a simple enhancement module to incorporate an autoencoder. Our proposed network cannot only generate soft tissue images with a high bone suppression rate but also possesses the capability to capture fine image details. Additionally, we compiled the largest dataset since 2010, including data from 120 patients with high-definition, high-resolution paired CXRs and soft tissue images collected by our affiliated hospital. Extensive experiments, comparative analyses, ablation studies, and clinical evaluations indicate that the proposed BS-Diff outperforms several bone-suppression models across multiple metrics. Our code can be accessed at https://github.com/Benny0323/BS-Diff.

Chest X-Ray (CXR) imaging for pulmonary diagnosis raises significant challenges, primarily because bone structures can obscure critical details necessary for accurate diagnosis. Recent advances in deep learning, particularly with diffusion models, offer significant promise for effectively minimizing the visibility of bone structures in CXR images, thereby improving clarity and diagnostic accuracy. Nevertheless, existing diffusion-based methods for bone suppression in CXR imaging struggle to balance the complete suppression of bones with preserving local texture details. Additionally, their high computational demand and extended processing time hinder their practical use in clinical settings. To address these limitations, we introduce a Global-Local Latent Consistency Model (GL-LCM) architecture. This model combines lung segmentation, dual-path sampling, and global-local fusion, enabling fast high-resolution bone suppression in CXR images. To tackle potential boundary artifacts and detail blurring in local-path sampling, we further propose Local-Enhanced Guidance, which addresses these issues without additional training. Comprehensive experiments on a self-collected dataset SZCH-X-Rays, and the public dataset JSRT, reveal that our GL-LCM delivers superior bone suppression and remarkable computational efficiency, significantly outperforming several competitive methods. Our code is available at https://github.com/diaoquesang/GL-LCM.

Typical neural network trainings have substantial variance in test-set performance between repeated runs, impeding hyperparameter comparison and training reproducibility. We present the following results towards understanding this variation. (1) Despite having significant variance on their test-sets, we demonstrate that standard CIFAR-10 and ImageNet trainings have very little variance in their performance on the test-distributions from which those test-sets are sampled, suggesting that variance is less of a practical issue than previously thought. (2) We present a simplifying statistical assumption which closely approximates the structure of the test-set accuracy distribution. (3) We argue that test-set variance is inevitable in the following two senses. First, we show that variance is largely caused by high sensitivity of the training process to initial conditions, rather than by specific sources of randomness like the data order and augmentations. Second, we prove that variance is unavoidable given the observation that ensembles of trained networks are well-calibrated. (4) We conduct preliminary studies of distribution-shift, fine-tuning, data augmentation and learning rate through the lens of variance between runs.

Medical image restoration (MedIR) aims to recover high-quality medical images from their low-quality counterparts. Recent advancements in MedIR have focused on All-in-One models capable of simultaneously addressing multiple different MedIR tasks. However, due to significant differences in both modality and degradation types, using a shared model for these diverse tasks requires careful consideration of two critical inter-task relationships: task interference, which occurs when conflicting gradient update directions arise across tasks on the same parameter, and task imbalance, which refers to uneven optimization caused by varying learning difficulties inherent to each task. To address these challenges, we propose a task-adaptive Transformer (TAT), a novel framework that dynamically adapts to different tasks through two key innovations. First, a task-adaptive weight generation strategy is introduced to mitigate task interference by generating task-specific weight parameters for each task, thereby eliminating potential gradient conflicts on shared weight parameters. Second, a task-adaptive loss balancing strategy is introduced to dynamically adjust loss weights based on task-specific learning difficulties, preventing task domination or undertraining. Extensive experiments demonstrate that our proposed TAT achieves state-of-the-art performance in three MedIR tasks--PET synthesis, CT denoising, and MRI super-resolution--both in task-specific and All-in-One settings. Code is available at https://github.com/Yaziwel/TAT.

Inverse problems aim to determine parameters from observations, a crucial task in engineering and science. Lately, generative models, especially diffusion models, have gained popularity in this area for their ability to produce realistic solutions and their good mathematical properties. Despite their success, an important drawback of diffusion models is their sensitivity to the choice of variance schedule, which controls the dynamics of the diffusion process. Fine-tuning this schedule for specific applications is crucial but time-costly and does not guarantee an optimal result. We propose a novel approach for learning the schedule as part of the training process. Our method supports probabilistic conditioning on data, provides high-quality solutions, and is flexible, proving able to adapt to different applications with minimum overhead. This approach is tested in two unrelated inverse problems: super-resolution microscopy and quantitative phase imaging, yielding comparable or superior results to previous methods and fine-tuned diffusion models. We conclude that fine-tuning the schedule by experimentation should be avoided because it can be learned during training in a stable way that yields better results.

Denoising diffusion models have recently shown impressive results in generative tasks. By learning powerful priors from huge collections of training images, such models are able to gradually modify complete noise to a clean natural image via a sequence of small denoising steps, seemingly making them well-suited for single image denoising. However, effectively applying denoising diffusion models to removal of realistic noise is more challenging than it may seem, since their formulation is based on additive white Gaussian noise, unlike noise in real-world images. In this work, we present SVNR, a novel formulation of denoising diffusion that assumes a more realistic, spatially-variant noise model. SVNR enables using the noisy input image as the starting point for the denoising diffusion process, in addition to conditioning the process on it. To this end, we adapt the diffusion process to allow each pixel to have its own time embedding, and propose training and inference schemes that support spatially-varying time maps. Our formulation also accounts for the correlation that exists between the condition image and the samples along the modified diffusion process. In our experiments we demonstrate the advantages of our approach over a strong diffusion model baseline, as well as over a state-of-the-art single image denoising method.

Accurate classification of computed tomography (CT) images is essential for diagnosis and treatment planning, but existing methods often struggle with the subtle and spatially diverse nature of pathological features. Current approaches typically process images uniformly, limiting their ability to detect localized abnormalities that require focused analysis. We introduce UGPL, an uncertainty-guided progressive learning framework that performs a global-to-local analysis by first identifying regions of diagnostic ambiguity and then conducting detailed examination of these critical areas. Our approach employs evidential deep learning to quantify predictive uncertainty, guiding the extraction of informative patches through a non-maximum suppression mechanism that maintains spatial diversity. This progressive refinement strategy, combined with an adaptive fusion mechanism, enables UGPL to integrate both contextual information and fine-grained details. Experiments across three CT datasets demonstrate that UGPL consistently outperforms state-of-the-art methods, achieving improvements of 3.29%, 2.46%, and 8.08% in accuracy for kidney abnormality, lung cancer, and COVID-19 detection, respectively. Our analysis shows that the uncertainty-guided component provides substantial benefits, with performance dramatically increasing when the full progressive learning pipeline is implemented. Our code is available at: https://github.com/shravan-18/UGPL

Recently, diffusion models have made remarkable progress in text-to-image (T2I) generation, synthesizing images with high fidelity and diverse contents. Despite this advancement, latent space smoothness within diffusion models remains largely unexplored. Smooth latent spaces ensure that a perturbation on an input latent corresponds to a steady change in the output image. This property proves beneficial in downstream tasks, including image interpolation, inversion, and editing. In this work, we expose the non-smoothness of diffusion latent spaces by observing noticeable visual fluctuations resulting from minor latent variations. To tackle this issue, we propose Smooth Diffusion, a new category of diffusion models that can be simultaneously high-performing and smooth. Specifically, we introduce Step-wise Variation Regularization to enforce the proportion between the variations of an arbitrary input latent and that of the output image is a constant at any diffusion training step. In addition, we devise an interpolation standard deviation (ISTD) metric to effectively assess the latent space smoothness of a diffusion model. Extensive quantitative and qualitative experiments demonstrate that Smooth Diffusion stands out as a more desirable solution not only in T2I generation but also across various downstream tasks. Smooth Diffusion is implemented as a plug-and-play Smooth-LoRA to work with various community models. Code is available at https://github.com/SHI-Labs/Smooth-Diffusion.

This paper investigates the application of unsupervised learning methods for computed tomography (CT) reconstruction. To motivate our work, we review several existing priors, namely the truncated Gaussian prior, the l_1 prior, the total variation prior, and the deep image prior (DIP). We find that DIP outperforms the other three priors in terms of representational capability and visual performance. However, the performance of DIP deteriorates when the number of iterations exceeds a certain threshold due to overfitting. To address this issue, we propose a novel method (MCDIP-ADMM) based on Multi-Code Deep Image Prior and plug-and-play Alternative Direction Method of Multipliers. Specifically, MCDIP utilizes multiple latent codes to generate a series of feature maps at an intermediate layer within a generator model. These maps are then composed with trainable weights, representing the complete image prior. Experimental results demonstrate the superior performance of the proposed MCDIP-ADMM compared to three existing competitors. In the case of parallel beam projection with Gaussian noise, MCDIP-ADMM achieves an average improvement of 4.3 dB over DIP, 1.7 dB over ADMM DIP-WTV, and 1.2 dB over PnP-DIP in terms of PSNR. Similarly, for fan-beam projection with Poisson noise, MCDIP-ADMM achieves an average improvement of 3.09 dB over DIP, 1.86 dB over ADMM DIP-WTV, and 0.84 dB over PnP-DIP in terms of PSNR.

Accurate medical image segmentation is crucial for precise anatomical delineation. Deep learning models like U-Net have shown great success but depend heavily on large datasets and struggle with domain shifts, complex structures, and limited training samples. Recent studies have explored diffusion models for segmentation by iteratively refining masks. However, these methods still retain the conventional image-to-mask mapping, making them highly sensitive to input data, which hampers stability and generalization. In contrast, we introduce DiffAtlas, a novel generative framework that models both images and masks through diffusion during training, effectively ``GenAI-fying'' atlas-based segmentation. During testing, the model is guided to generate a specific target image-mask pair, from which the corresponding mask is obtained. DiffAtlas retains the robustness of the atlas paradigm while overcoming its scalability and domain-specific limitations. Extensive experiments on CT and MRI across same-domain, cross-modality, varying-domain, and different data-scale settings using the MMWHS and TotalSegmentator datasets demonstrate that our approach outperforms existing methods, particularly in limited-data and zero-shot modality segmentation. Code is available at https://github.com/M3DV/DiffAtlas.

Image denoising is a fundamental problem in computational photography, where achieving high perception with low distortion is highly demanding. Current methods either struggle with perceptual quality or suffer from significant distortion. Recently, the emerging diffusion model has achieved state-of-the-art performance in various tasks and demonstrates great potential for image denoising. However, stimulating diffusion models for image denoising is not straightforward and requires solving several critical problems. For one thing, the input inconsistency hinders the connection between diffusion models and image denoising. For another, the content inconsistency between the generated image and the desired denoised image introduces distortion. To tackle these problems, we present a novel strategy called the Diffusion Model for Image Denoising (DMID) by understanding and rethinking the diffusion model from a denoising perspective. Our DMID strategy includes an adaptive embedding method that embeds the noisy image into a pre-trained unconditional diffusion model and an adaptive ensembling method that reduces distortion in the denoised image. Our DMID strategy achieves state-of-the-art performance on both distortion-based and perception-based metrics, for both Gaussian and real-world image denoising.The code is available at https://github.com/Li-Tong-621/DMID.

In medical imaging, vision-language models face a critical duality: pretrained networks offer broad robustness but lack subtle, modality-specific characteristics, while fine-tuned expert models achieve high in-distribution accuracy yet falter under modality shift. Existing model-merging techniques, designed for natural-image benchmarks, are simple and efficient but fail to deliver consistent gains across diverse medical modalities; their static interpolation limits reliability in varied clinical tasks. To address this, we introduce Test-Time Task adaptive merging (T^3), a backpropagation-free framework that computes per-sample interpolation coefficients via the Jensen-Shannon divergence between the two models' output distributions. T^3 dynamically preserves local precision when models agree and defers to generalist robustness under drift. To overcome the inference costs of sample-wise merging, we further propose a batch-wise extension, T^3_B, that computes a merging coefficient across a batch of samples, dramatically reducing computational bottleneck. Recognizing the lack of a standardized medical-merging benchmark, we present a rigorous cross-evaluation protocol spanning in-domain, base-to-novel, and corruptions across four modalities. Empirically, T^3 sets new state-of-the-art in Top-1 accuracy and error reduction, outperforming strong baselines while maintaining efficiency, paving the way for adaptive MVLM deployment in clinical settings. Our code is available at https://github.com/Razaimam45/TCube.

Image similarity metrics play an important role in computer vision applications, as they are used in image processing, computer vision and machine learning. Furthermore, those metrics enable tasks such as image retrieval, object recognition and quality assessment, essential in fields like healthcare, astronomy and surveillance. Existing metrics, such as PSNR, MSE, SSIM, ISSM and FSIM, often face limitations in terms of either speed, complexity or sensitivity to small changes in images. To address these challenges, a novel image similarity metric, namely CSIM, that combines real-time while being sensitive to subtle image variations is investigated in this paper. The novel metric uses Gaussian Copula from probability theory to transform an image into vectors of pixel distribution associated to local image patches. These vectors contain, in addition to intensities and pixel positions, information on the dependencies between pixel values, capturing the structural relationships within the image. By leveraging the properties of Copulas, CSIM effectively models the joint distribution of pixel intensities, enabling a more nuanced comparison of image patches making it more sensitive to local changes compared to other metrics. Experimental results demonstrate that CSIM outperforms existing similarity metrics in various image distortion scenarios, including noise, compression artifacts and blur. The metric's ability to detect subtle differences makes it suitable for applications requiring high precision, such as medical imaging, where the detection of minor anomalies can be of a high importance. The results obtained in this work can be reproduced from this Github repository: https://github.com/safouaneelg/copulasimilarity.

Low-light photography produces images with low signal-to-noise ratios due to limited photons. In such conditions, common approximations like the Gaussian noise model fall short, and many denoising techniques fail to remove noise effectively. Although deep-learning methods perform well, they require large datasets of paired images that are impractical to acquire. As a remedy, synthesizing realistic low-light noise has gained significant attention. In this paper, we investigate the ability of diffusion models to capture the complex distribution of low-light noise. We show that a naive application of conventional diffusion models is inadequate for this task and propose three key adaptations that enable high-precision noise generation without calibration or post-processing: a two-branch architecture to better model signal-dependent and signal-independent noise, the incorporation of positional information to capture fixed-pattern noise, and a tailored diffusion noise schedule. Consequently, our model enables the generation of large datasets for training low-light denoising networks, leading to state-of-the-art performance. Through comprehensive analysis, including statistical evaluation and noise decomposition, we provide deeper insights into the characteristics of the generated data.

Multi-center positron emission tomography (PET) image synthesis aims at recovering low-dose PET images from multiple different centers. The generalizability of existing methods can still be suboptimal for a multi-center study due to domain shifts, which result from non-identical data distribution among centers with different imaging systems/protocols. While some approaches address domain shifts by training specialized models for each center, they are parameter inefficient and do not well exploit the shared knowledge across centers. To address this, we develop a generalist model that shares architecture and parameters across centers to utilize the shared knowledge. However, the generalist model can suffer from the center interference issue, i.e. the gradient directions of different centers can be inconsistent or even opposite owing to the non-identical data distribution. To mitigate such interference, we introduce a novel dynamic routing strategy with cross-layer connections that routes data from different centers to different experts. Experiments show that our generalist model with dynamic routing (DRMC) exhibits excellent generalizability across centers. Code and data are available at: https://github.com/Yaziwel/Multi-Center-PET-Image-Synthesis.

Quality control is of vital importance during electronics production. As the methods of producing electronic circuits improve, there is an increasing chance of solder defects during assembling the printed circuit board (PCB). Many technologies have been incorporated for inspecting failed soldering, such as X-ray imaging, optical imaging, and thermal imaging. With some advanced algorithms, the new technologies are expected to control the production quality based on the digital images. However, current algorithms sometimes are not accurate enough to meet the quality control. Specialists are needed to do a follow-up checking. For automated X-ray inspection, joint of interest on the X-ray image is located by region of interest (ROI) and inspected by some algorithms. Some incorrect ROIs deteriorate the inspection algorithm. The high dimension of X-ray images and the varying sizes of image dimensions also challenge the inspection algorithms. On the other hand, recent advances on deep learning shed light on image-based tasks and are competitive to human levels. In this paper, deep learning is incorporated in X-ray imaging based quality control during PCB quality inspection. Two artificial intelligence (AI) based models are proposed and compared for joint defect detection. The noised ROI problem and the varying sizes of imaging dimension problem are addressed. The efficacy of the proposed methods are verified through experimenting on a real-world 3D X-ray dataset. By incorporating the proposed methods, specialist inspection workload is largely saved.

Previous raw image-based low-light image enhancement methods predominantly relied on feed-forward neural networks to learn deterministic mappings from low-light to normally-exposed images. However, they failed to capture critical distribution information, leading to visually undesirable results. This work addresses the issue by seamlessly integrating a diffusion model with a physics-based exposure model. Different from a vanilla diffusion model that has to perform Gaussian denoising, with the injected physics-based exposure model, our restoration process can directly start from a noisy image instead of pure noise. As such, our method obtains significantly improved performance and reduced inference time compared with vanilla diffusion models. To make full use of the advantages of different intermediate steps, we further propose an adaptive residual layer that effectively screens out the side-effect in the iterative refinement when the intermediate results have been already well-exposed. The proposed framework can work with both real-paired datasets, SOTA noise models, and different backbone networks. Note that, the proposed framework is compatible with real-paired datasets, real/synthetic noise models, and different backbone networks. We evaluate the proposed method on various public benchmarks, achieving promising results with consistent improvements using different exposure models and backbones. Besides, the proposed method achieves better generalization capacity for unseen amplifying ratios and better performance than a larger feedforward neural model when few parameters are adopted.

Score-based generative modeling, informally referred to as diffusion models, continue to grow in popularity across several important domains and tasks. While they provide high-quality and diverse samples from empirical distributions, important questions remain on the reliability and trustworthiness of these sampling procedures for their responsible use in critical scenarios. Conformal prediction is a modern tool to construct finite-sample, distribution-free uncertainty guarantees for any black-box predictor. In this work, we focus on image-to-image regression tasks and we present a generalization of the Risk-Controlling Prediction Sets (RCPS) procedure, that we term K-RCPS, which allows to (i) provide entrywise calibrated intervals for future samples of any diffusion model, and (ii) control a certain notion of risk with respect to a ground truth image with minimal mean interval length. Differently from existing conformal risk control procedures, ours relies on a novel convex optimization approach that allows for multidimensional risk control while provably minimizing the mean interval length. We illustrate our approach on two real-world image denoising problems: on natural images of faces as well as on computed tomography (CT) scans of the abdomen, demonstrating state of the art performance.

Real-world single image denoising is crucial and practical in computer vision. Bayesian inversions combined with score priors now have proven effective for single image denoising but are limited to white Gaussian noise. Moreover, applying existing score-based methods for real-world denoising requires not only the explicit train of score priors on the target domain but also the careful design of sampling procedures for posterior inference, which is complicated and impractical. To address these limitations, we propose a score priors-guided deep variational inference, namely ScoreDVI, for practical real-world denoising. By considering the deep variational image posterior with a Gaussian form, score priors are extracted based on easily accessible minimum MSE Non-i.i.d Gaussian denoisers and variational samples, which in turn facilitate optimizing the variational image posterior. Such a procedure adaptively applies cheap score priors to denoising. Additionally, we exploit a Non-i.i.d Gaussian mixture model and variational noise posterior to model the real-world noise. This scheme also enables the pixel-wise fusion of multiple image priors and variational image posteriors. Besides, we develop a noise-aware prior assignment strategy that dynamically adjusts the weight of image priors in the optimization. Our method outperforms other single image-based real-world denoising methods and achieves comparable performance to dataset-based unsupervised methods.

Deformable image registration (DIR) is an active research topic in biomedical imaging. There is a growing interest in developing DIR methods based on deep learning (DL). A traditional DL approach to DIR is based on training a convolutional neural network (CNN) to estimate the registration field between two input images. While conceptually simple, this approach comes with a limitation that it exclusively relies on a pre-trained CNN without explicitly enforcing fidelity between the registered image and the reference. We present plug-and-play image registration network (PIRATE) as a new DIR method that addresses this issue by integrating an explicit data-fidelity penalty and a CNN prior. PIRATE pre-trains a CNN denoiser on the registration field and "plugs" it into an iterative method as a regularizer. We additionally present PIRATE+ that fine-tunes the CNN prior in PIRATE using deep equilibrium models (DEQ). PIRATE+ interprets the fixed-point iteration of PIRATE as a network with effectively infinite layers and then trains the resulting network end-to-end, enabling it to learn more task-specific information and boosting its performance. Our numerical results on OASIS and CANDI datasets show that our methods achieve state-of-the-art performance on DIR.

Text-guided diffusion models have become a popular tool in image synthesis, known for producing high-quality and diverse images. However, their application to editing real images often encounters hurdles primarily due to the text condition deteriorating the reconstruction quality and subsequently affecting editing fidelity. Null-text Inversion (NTI) has made strides in this area, but it fails to capture spatial context and requires computationally intensive per-timestep optimization. Addressing these challenges, we present Noise Map Guidance (NMG), an inversion method rich in a spatial context, tailored for real-image editing. Significantly, NMG achieves this without necessitating optimization, yet preserves the editing quality. Our empirical investigations highlight NMG's adaptability across various editing techniques and its robustness to variants of DDIM inversions.

Metalenses offer significant potential for ultra-compact computational imaging but face challenges from complex optical degradation and computational restoration difficulties. Existing methods typically rely on precise optical calibration or massive paired datasets, which are non-trivial for real-world imaging systems. Furthermore, a lack of control over the inference process often results in undesirable hallucinated artifacts. We introduce Degradation-Modeled Multipath Diffusion for tunable metalens photography, leveraging powerful natural image priors from pretrained models instead of large datasets. Our framework uses positive, neutral, and negative-prompt paths to balance high-frequency detail generation, structural fidelity, and suppression of metalens-specific degradation, alongside pseudo data augmentation. A tunable decoder enables controlled trade-offs between fidelity and perceptual quality. Additionally, a spatially varying degradation-aware attention (SVDA) module adaptively models complex optical and sensor-induced degradation. Finally, we design and build a millimeter-scale MetaCamera for real-world validation. Extensive results show that our approach outperforms state-of-the-art methods, achieving high-fidelity and sharp image reconstruction. More materials: https://dmdiff.github.io/.

Dynamic contrast-enhanced (DCE) MRI is essential for breast cancer diagnosis and treatment. However, its reliance on contrast agents introduces safety concerns, contraindications, increased cost, and workflow complexity. To this end, we present pre-contrast conditioned denoising diffusion probabilistic models to synthesize DCE-MRI, introducing, evaluating, and comparing a total of 22 generative model variants in both single-breast and full breast settings. Towards enhancing lesion fidelity, we introduce both tumor-aware loss functions and explicit tumor segmentation mask conditioning. Using a public multicenter dataset and comparing to respective pre-contrast baselines, we observe that subtraction image-based models consistently outperform post-contrast-based models across five complementary evaluation metrics. Apart from assessing the entire image, we also separately evaluate the region of interest, where both tumor-aware losses and segmentation mask inputs improve evaluation metrics. The latter notably enhance qualitative results capturing contrast uptake, albeit assuming access to tumor localization inputs that are not guaranteed to be available in screening settings. A reader study involving 2 radiologists and 4 MRI technologists confirms the high realism of the synthetic images, indicating an emerging clinical potential of generative contrast-enhancement. We share our codebase at https://github.com/sebastibar/conditional-diffusion-breast-MRI.

Despite the remarkable success of diffusion models in image generation, slow sampling remains a persistent issue. To accelerate the sampling process, prior studies have reformulated diffusion sampling as an ODE/SDE and introduced higher-order numerical methods. However, these methods often produce divergence artifacts, especially with a low number of sampling steps, which limits the achievable acceleration. In this paper, we investigate the potential causes of these artifacts and suggest that the small stability regions of these methods could be the principal cause. To address this issue, we propose two novel techniques. The first technique involves the incorporation of Heavy Ball (HB) momentum, a well-known technique for improving optimization, into existing diffusion numerical methods to expand their stability regions. We also prove that the resulting methods have first-order convergence. The second technique, called Generalized Heavy Ball (GHVB), constructs a new high-order method that offers a variable trade-off between accuracy and artifact suppression. Experimental results show that our techniques are highly effective in reducing artifacts and improving image quality, surpassing state-of-the-art diffusion solvers on both pixel-based and latent-based diffusion models for low-step sampling. Our research provides novel insights into the design of numerical methods for future diffusion work.

In recent years, large convolutional neural networks have been widely used as tools for image deblurring, because of their ability in restoring images very precisely. It is well known that image deblurring is mathematically modeled as an ill-posed inverse problem and its solution is difficult to approximate when noise affects the data. Really, one limitation of neural networks for deblurring is their sensitivity to noise and other perturbations, which can lead to instability and produce poor reconstructions. In addition, networks do not necessarily take into account the numerical formulation of the underlying imaging problem, when trained end-to-end. In this paper, we propose some strategies to improve stability without losing to much accuracy to deblur images with deep-learning based methods. First, we suggest a very small neural architecture, which reduces the execution time for training, satisfying a green AI need, and does not extremely amplify noise in the computed image. Second, we introduce a unified framework where a pre-processing step balances the lack of stability of the following, neural network-based, step. Two different pre-processors are presented: the former implements a strong parameter-free denoiser, and the latter is a variational model-based regularized formulation of the latent imaging problem. This framework is also formally characterized by mathematical analysis. Numerical experiments are performed to verify the accuracy and stability of the proposed approaches for image deblurring when unknown or not-quantified noise is present; the results confirm that they improve the network stability with respect to noise. In particular, the model-based framework represents the most reliable trade-off between visual precision and robustness.

Denoising diffusion models have enabled high-quality image generation and editing. We present a method to localize the desired edit region implicit in a text instruction. We leverage InstructPix2Pix (IP2P) and identify the discrepancy between IP2P predictions with and without the instruction. This discrepancy is referred to as the relevance map. The relevance map conveys the importance of changing each pixel to achieve the edits, and is used to to guide the modifications. This guidance ensures that the irrelevant pixels remain unchanged. Relevance maps are further used to enhance the quality of text-guided editing of 3D scenes in the form of neural radiance fields. A field is trained on relevance maps of training views, denoted as the relevance field, defining the 3D region within which modifications should be made. We perform iterative updates on the training views guided by rendered relevance maps from the relevance field. Our method achieves state-of-the-art performance on both image and NeRF editing tasks. Project page: https://ashmrz.github.io/WatchYourSteps/

With the proliferation of algorithmic decision-making, increased scrutiny has been placed on these systems. This paper explores the relationship between the quality of the training data and the overall fairness of the models trained with such data in the context of supervised classification. We measure key fairness metrics across a range of algorithms over multiple image classification datasets that have a varying level of noise in both the labels and the training data itself. We describe noise in the labels as inaccuracies in the labelling of the data in the training set and noise in the data as distortions in the data, also in the training set. By adding noise to the original datasets, we can explore the relationship between the quality of the training data and the fairness of the output of the models trained on that data.

It is important to detect anomalous inputs when deploying machine learning systems. The use of larger and more complex inputs in deep learning magnifies the difficulty of distinguishing between anomalous and in-distribution examples. At the same time, diverse image and text data are available in enormous quantities. We propose leveraging these data to improve deep anomaly detection by training anomaly detectors against an auxiliary dataset of outliers, an approach we call Outlier Exposure (OE). This enables anomaly detectors to generalize and detect unseen anomalies. In extensive experiments on natural language processing and small- and large-scale vision tasks, we find that Outlier Exposure significantly improves detection performance. We also observe that cutting-edge generative models trained on CIFAR-10 may assign higher likelihoods to SVHN images than to CIFAR-10 images; we use OE to mitigate this issue. We also analyze the flexibility and robustness of Outlier Exposure, and identify characteristics of the auxiliary dataset that improve performance.

Datasets play a critical role in medical imaging research, yet issues such as label quality, shortcuts, and metadata are often overlooked. This lack of attention may harm the generalizability of algorithms and, consequently, negatively impact patient outcomes. While existing medical imaging literature reviews mostly focus on machine learning (ML) methods, with only a few focusing on datasets for specific applications, these reviews remain static -- they are published once and not updated thereafter. This fails to account for emerging evidence, such as biases, shortcuts, and additional annotations that other researchers may contribute after the dataset is published. We refer to these newly discovered findings of datasets as research artifacts. To address this gap, we propose a living review that continuously tracks public datasets and their associated research artifacts across multiple medical imaging applications. Our approach includes a framework for the living review to monitor data documentation artifacts, and an SQL database to visualize the citation relationships between research artifact and dataset. Lastly, we discuss key considerations for creating medical imaging datasets, review best practices for data annotation, discuss the significance of shortcuts and demographic diversity, and emphasize the importance of managing datasets throughout their entire lifecycle. Our demo is publicly available at http://inthepicture.itu.dk/.

Uncertainty estimation is essential for the safe clinical deployment of medical image segmentation systems, enabling the identification of unreliable predictions and supporting human oversight. While prior work has largely focused on pixel-level uncertainty, landmark-based segmentation offers inherent topological guarantees yet remains underexplored from an uncertainty perspective. In this work, we study uncertainty estimation for anatomical landmark-based segmentation on chest X-rays. Inspired by hybrid neural network architectures that combine standard image convolutional encoders with graph-based generative decoders, and leveraging their variational latent space, we derive two complementary measures: (i) latent uncertainty, captured directly from the learned distribution parameters, and (ii) predictive uncertainty, obtained by generating multiple stochastic output predictions from latent samples. Through controlled corruption experiments we show that both uncertainty measures increase with perturbation severity, reflecting both global and local degradation. We demonstrate that these uncertainty signals can identify unreliable predictions by comparing with manual ground-truth, and support out-of-distribution detection on the CheXmask dataset. More importantly, we release CheXmask-U (huggingface.co/datasets/mcosarinsky/CheXmask-U), a large scale dataset of 657,566 chest X-ray landmark segmentations with per-node uncertainty estimates, enabling researchers to account for spatial variations in segmentation quality when using these anatomical masks. Our findings establish uncertainty estimation as a promising direction to enhance robustness and safe deployment of landmark-based anatomical segmentation methods in chest X-ray. A fully working interactive demo of the method is available at huggingface.co/spaces/matiasky/CheXmask-U and the source code at github.com/mcosarinsky/CheXmask-U.

Medical image segmentation faces critical challenges in semi-supervised learning scenarios due to severe annotation scarcity requiring expert radiological knowledge, significant inter-annotator variability across different viewpoints and expertise levels, and inadequate multi-scale feature integration for precise boundary delineation in complex anatomical structures. Existing semi-supervised methods demonstrate substantial performance degradation compared to fully supervised approaches, particularly in small target segmentation and boundary refinement tasks. To address these fundamental challenges, we propose SASNet (Scale-aware Adaptive Supervised Network), a dual-branch architecture that leverages both low-level and high-level feature representations through novel scale-aware adaptive reweight mechanisms. Our approach introduces three key methodological innovations, including the Scale-aware Adaptive Reweight strategy that dynamically weights pixel-wise predictions using temporal confidence accumulation, the View Variance Enhancement mechanism employing 3D Fourier domain transformations to simulate annotation variability, and segmentation-regression consistency learning through signed distance map algorithms for enhanced boundary precision. These innovations collectively address the core limitations of existing semi-supervised approaches by integrating spatial, temporal, and geometric consistency principles within a unified optimization framework. Comprehensive evaluation across LA, Pancreas-CT, and BraTS datasets demonstrates that SASNet achieves superior performance with limited labeled data, surpassing state-of-the-art semi-supervised methods while approaching fully supervised performance levels. The source code for SASNet is available at https://github.com/HUANGLIZI/SASNet.

When an image classifier makes a prediction, which parts of the image are relevant and why? We can rephrase this question to ask: which parts of the image, if they were not seen by the classifier, would most change its decision? Producing an answer requires marginalizing over images that could have been seen but weren't. We can sample plausible image in-fills by conditioning a generative model on the rest of the image. We then optimize to find the image regions that most change the classifier's decision after in-fill. Our approach contrasts with ad-hoc in-filling approaches, such as blurring or injecting noise, which generate inputs far from the data distribution, and ignore informative relationships between different parts of the image. Our method produces more compact and relevant saliency maps, with fewer artifacts compared to previous methods.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Brain MRI scans are often found in four modalities, consisting of T1-weighted with and without contrast enhancement (T1ce and T1w), T2-weighted imaging (T2w), and Flair. Leveraging complementary information from these different modalities enables models to learn richer, more discriminative features for understanding brain anatomy, which could be used in downstream tasks such as anomaly detection. However, in clinical practice, not all MRI modalities are always available due to various reasons. This makes missing modality generation a critical challenge in medical image analysis. In this paper, we propose SLaM-DiMM, a novel missing modality generation framework that harnesses the power of diffusion models to synthesize any of the four target MRI modalities from other available modalities. Our approach not only generates high-fidelity images but also ensures structural coherence across the depth of the volume through a dedicated coherence enhancement mechanism. Qualitative and quantitative evaluations on the BraTS-Lighthouse-2025 Challenge dataset demonstrate the effectiveness of the proposed approach in synthesizing anatomically plausible and structurally consistent results. Code is available at https://github.com/BheeshmSharma/SLaM-DiMM-MICCAI-BraTS-Challenge-2025.

This work addresses the challenge of high-quality surface normal estimation from monocular colored inputs (i.e., images and videos), a field which has recently been revolutionized by repurposing diffusion priors. However, previous attempts still struggle with stochastic inference, conflicting with the deterministic nature of the Image2Normal task, and costly ensembling step, which slows down the estimation process. Our method, StableNormal, mitigates the stochasticity of the diffusion process by reducing inference variance, thus producing "Stable-and-Sharp" normal estimates without any additional ensembling process. StableNormal works robustly under challenging imaging conditions, such as extreme lighting, blurring, and low quality. It is also robust against transparent and reflective surfaces, as well as cluttered scenes with numerous objects. Specifically, StableNormal employs a coarse-to-fine strategy, which starts with a one-step normal estimator (YOSO) to derive an initial normal guess, that is relatively coarse but reliable, then followed by a semantic-guided refinement process (SG-DRN) that refines the normals to recover geometric details. The effectiveness of StableNormal is demonstrated through competitive performance in standard datasets such as DIODE-indoor, iBims, ScannetV2 and NYUv2, and also in various downstream tasks, such as surface reconstruction and normal enhancement. These results evidence that StableNormal retains both the "stability" and "sharpness" for accurate normal estimation. StableNormal represents a baby attempt to repurpose diffusion priors for deterministic estimation. To democratize this, code and models have been publicly available in hf.co/Stable-X

Generally, the small size of public medical imaging datasets coupled with stringent privacy concerns, hampers the advancement of data-hungry deep learning models in medical imaging. This study addresses these challenges for 3D cardiac MRI images in the short-axis view. We propose Latent Diffusion Models that generate synthetic images conditioned on medical attributes, while ensuring patient privacy through differentially private model training. To our knowledge, this is the first work to apply and quantify differential privacy in 3D medical image generation. We pre-train our models on public data and finetune them with differential privacy on the UK Biobank dataset. Our experiments reveal that pre-training significantly improves model performance, achieving a Fréchet Inception Distance (FID) of 26.77 at ε=10, compared to 92.52 for models without pre-training. Additionally, we explore the trade-off between privacy constraints and image quality, investigating how tighter privacy budgets affect output controllability and may lead to degraded performance. Our results demonstrate that proper consideration during training with differential privacy can substantially improve the quality of synthetic cardiac MRI images, but there are still notable challenges in achieving consistent medical realism.

Diffusion models have demonstrated compelling generation quality by optimizing the variational lower bound through a simple denoising score matching loss. In this paper, we provide theoretical evidence that the prevailing practice of using a constant loss weight strategy in diffusion models leads to biased estimation during the training phase. Simply optimizing the denoising network to predict Gaussian noise with constant weighting may hinder precise estimations of original images. To address the issue, we propose an elegant and effective weighting strategy grounded in the theoretically unbiased principle. Moreover, we conduct a comprehensive and systematic exploration to dissect the inherent bias problem deriving from constant weighting loss from the perspectives of its existence, impact and reasons. These analyses are expected to advance our understanding and demystify the inner workings of diffusion models. Through empirical evaluation, we demonstrate that our proposed debiased estimation method significantly enhances sample quality without the reliance on complex techniques, and exhibits improved efficiency compared to the baseline method both in training and sampling processes.

Fairness in image restoration tasks is the desire to treat different sub-groups of images equally well. Existing definitions of fairness in image restoration are highly restrictive. They consider a reconstruction to be a correct outcome for a group (e.g., women) only if it falls within the group's set of ground truth images (e.g., natural images of women); otherwise, it is considered entirely incorrect. Consequently, such definitions are prone to controversy, as errors in image restoration can manifest in various ways. In this work we offer an alternative approach towards fairness in image restoration, by considering the Group Perceptual Index (GPI), which we define as the statistical distance between the distribution of the group's ground truth images and the distribution of their reconstructions. We assess the fairness of an algorithm by comparing the GPI of different groups, and say that it achieves perfect Perceptual Fairness (PF) if the GPIs of all groups are identical. We motivate and theoretically study our new notion of fairness, draw its connection to previous ones, and demonstrate its utility on state-of-the-art face image super-resolution algorithms.

Critical retained foreign objects (RFOs), including surgical instruments like sponges and needles, pose serious patient safety risks and carry significant financial and legal implications for healthcare institutions. Detecting critical RFOs using artificial intelligence remains challenging due to their rarity and the limited availability of chest X-ray datasets that specifically feature critical RFOs cases. Existing datasets only contain non-critical RFOs, like necklace or zipper, further limiting their utility for developing clinically impactful detection algorithms. To address these limitations, we introduce "Hopkins RFOs Bench", the first and largest dataset of its kind, containing 144 chest X-ray images of critical RFO cases collected over 18 years from the Johns Hopkins Health System. Using this dataset, we benchmark several state-of-the-art object detection models, highlighting the need for enhanced detection methodologies for critical RFO cases. Recognizing data scarcity challenges, we further explore image synthetic methods to bridge this gap. We evaluate two advanced synthetic image methods, DeepDRR-RFO, a physics-based method, and RoentGen-RFO, a diffusion-based method, for creating realistic radiographs featuring critical RFOs. Our comprehensive analysis identifies the strengths and limitations of each synthetic method, providing insights into effectively utilizing synthetic data to enhance model training. The Hopkins RFOs Bench and our findings significantly advance the development of reliable, generalizable AI-driven solutions for detecting critical RFOs in clinical chest X-rays.

Casually captured Neural Radiance Fields (NeRFs) suffer from artifacts such as floaters or flawed geometry when rendered outside the camera trajectory. Existing evaluation protocols often do not capture these effects, since they usually only assess image quality at every 8th frame of the training capture. To push forward progress in novel-view synthesis, we propose a new dataset and evaluation procedure, where two camera trajectories are recorded of the scene: one used for training, and the other for evaluation. In this more challenging in-the-wild setting, we find that existing hand-crafted regularizers do not remove floaters nor improve scene geometry. Thus, we propose a 3D diffusion-based method that leverages local 3D priors and a novel density-based score distillation sampling loss to discourage artifacts during NeRF optimization. We show that this data-driven prior removes floaters and improves scene geometry for casual captures.

The Inversion-Denoising Paradigm, which is based on diffusion models, excels in diverse image editing and restoration tasks. We revisit its mechanism and reveal a critical, overlooked factor in reconstruction degradation: the approximate noise error. This error stems from approximating the noise at step t with the prediction at step t-1, resulting in severe error accumulation throughout the inversion process. We introduce Projection-Orthogonal Least Squares for Robust and Adaptive Inversion (POLARIS), which reformulates inversion from an error-compensation problem into an error-origin problem. Rather than optimizing embeddings or latent codes to offset accumulated drift, POLARIS treats the guidance scale ω as a step-wise variable and derives a mathematically grounded formula to minimize inversion error at each step. Remarkably, POLARIS improves inversion latent quality with just one line of code. With negligible performance overhead, it substantially mitigates noise approximation errors and consistently improves the accuracy of downstream tasks.

In MRI, images of the same contrast (e.g., T_1) from the same subject can exhibit noticeable differences when acquired using different hardware, sequences, or scan parameters. These differences in images create a domain gap that needs to be bridged by a step called image harmonization, to process the images successfully using conventional or deep learning-based image analysis (e.g., segmentation). Several methods, including deep learning-based approaches, have been proposed to achieve image harmonization. However, they often require datasets from multiple domains for deep learning training and may still be unsuccessful when applied to images from unseen domains. To address this limitation, we propose a novel concept called `Blind Harmonization', which utilizes only target domain data for training but still has the capability to harmonize images from unseen domains. For the implementation of blind harmonization, we developed BlindHarmony using an unconditional flow model trained on target domain data. The harmonized image is optimized to have a correlation with the input source domain image while ensuring that the latent vector of the flow model is close to the center of the Gaussian distribution. BlindHarmony was evaluated on both simulated and real datasets and compared to conventional methods. BlindHarmony demonstrated noticeable performance on both datasets, highlighting its potential for future use in clinical settings. The source code is available at: https://github.com/SNU-LIST/BlindHarmony

This work aims to improve the efficiency of text-to-image diffusion models. While diffusion models use computationally expensive UNet-based denoising operations in every generation step, we identify that not all operations are equally relevant for the final output quality. In particular, we observe that UNet layers operating on high-res feature maps are relatively sensitive to small perturbations. In contrast, low-res feature maps influence the semantic layout of the final image and can often be perturbed with no noticeable change in the output. Based on this observation, we propose Clockwork Diffusion, a method that periodically reuses computation from preceding denoising steps to approximate low-res feature maps at one or more subsequent steps. For multiple baselines, and for both text-to-image generation and image editing, we demonstrate that Clockwork leads to comparable or improved perceptual scores with drastically reduced computational complexity. As an example, for Stable Diffusion v1.5 with 8 DPM++ steps we save 32% of FLOPs with negligible FID and CLIP change.

Bias mitigation in image classification has been widely researched, and existing methods have yielded notable results. However, most of these methods implicitly assume that a given image contains only one type of known or unknown bias, failing to consider the complexities of real-world biases. We introduce a more challenging scenario, agnostic biases mitigation, aiming at bias removal regardless of whether the type of bias or the number of types is unknown in the datasets. To address this difficult task, we present the Partition-and-Debias (PnD) method that uses a mixture of biases-specific experts to implicitly divide the bias space into multiple subspaces and a gating module to find a consensus among experts to achieve debiased classification. Experiments on both public and constructed benchmarks demonstrated the efficacy of the PnD. Code is available at: https://github.com/Jiaxuan-Li/PnD.

The practical deployment of Visual Anomaly Detection (VAD) systems is hindered by their sensitivity to real-world imaging variations, particularly the complex interplay between viewpoint and illumination which drastically alters defect visibility. Current benchmarks largely overlook this critical challenge. We introduce Multi-View Multi-Illumination Anomaly Detection (M2AD), a new large-scale benchmark comprising 119,880 high-resolution images designed explicitly to probe VAD robustness under such interacting conditions. By systematically capturing 999 specimens across 10 categories using 12 synchronized views and 10 illumination settings (120 configurations total), M2AD enables rigorous evaluation. We establish two evaluation protocols: M2AD-Synergy tests the ability to fuse information across diverse configurations, and M2AD-Invariant measures single-image robustness against realistic view-illumination effects. Our extensive benchmarking shows that state-of-the-art VAD methods struggle significantly on M2AD, demonstrating the profound challenge posed by view-illumination interplay. This benchmark serves as an essential tool for developing and validating VAD methods capable of overcoming real-world complexities. Our full dataset and test suite will be released at https://hustcyq.github.io/M2AD to facilitate the field.

X-ray images play a vital role in the intraoperative processes due to their high resolution and fast imaging speed and greatly promote the subsequent segmentation, registration and reconstruction. However, over-dosed X-rays superimpose potential risks to human health to some extent. Data-driven algorithms from volume scans to X-ray images are restricted by the scarcity of paired X-ray and volume data. Existing methods are mainly realized by modelling the whole X-ray imaging procedure. In this study, we propose a learning-based approach termed CT2X-GAN to synthesize the X-ray images in an end-to-end manner using the content and style disentanglement from three different image domains. Our method decouples the anatomical structure information from CT scans and style information from unpaired real X-ray images/ digital reconstructed radiography (DRR) images via a series of decoupling encoders. Additionally, we introduce a novel consistency regularization term to improve the stylistic resemblance between synthesized X-ray images and real X-ray images. Meanwhile, we also impose a supervised process by computing the similarity of computed real DRR and synthesized DRR images. We further develop a pose attention module to fully strengthen the comprehensive information in the decoupled content code from CT scans, facilitating high-quality multi-view image synthesis in the lower 2D space. Extensive experiments were conducted on the publicly available CTSpine1K dataset and achieved 97.8350, 0.0842 and 3.0938 in terms of FID, KID and defined user-scored X-ray similarity, respectively. In comparison with 3D-aware methods (pi-GAN, EG3D), CT2X-GAN is superior in improving the synthesis quality and realistic to the real X-ray images.

The denoising process of diffusion models can be interpreted as an approximate projection of noisy samples onto the data manifold. Moreover, the noise level in these samples approximates their distance to the underlying manifold. Building on this insight, we propose a novel method to enhance sample generation by aligning the estimated noise level with the true distance of noisy samples to the manifold. Specifically, we introduce a noise level correction network, leveraging a pre-trained denoising network, to refine noise level estimates during the denoising process. Additionally, we extend this approach to various image restoration tasks by integrating task-specific constraints, including inpainting, deblurring, super-resolution, colorization, and compressed sensing. Experimental results demonstrate that our method significantly improves sample quality in both unconstrained and constrained generation scenarios. Notably, the proposed noise level correction framework is compatible with existing denoising schedulers (e.g., DDIM), offering additional performance improvements.

Neural posterior estimation (NPE), a type of amortized variational inference, is a computationally efficient means of constructing probabilistic catalogs of light sources from astronomical images. To date, NPE has not been used to perform inference in models with spatially varying covariates. However, ground-based astronomical images have spatially varying sky backgrounds and point spread functions (PSFs), and accounting for this variation is essential for constructing accurate catalogs of imaged light sources. In this work, we introduce a method of performing NPE with spatially varying backgrounds and PSFs. In this method, we generate synthetic catalogs and semi-synthetic images for these catalogs using randomly sampled PSF and background estimates from existing surveys. Using this data, we train a neural network, which takes an astronomical image and representations of its background and PSF as input, to output a probabilistic catalog. Our experiments with Sloan Digital Sky Survey data demonstrate the effectiveness of NPE in the presence of spatially varying backgrounds and PSFs for light source detection, star/galaxy separation, and flux measurement.

Current exposure correction methods have three challenges, labor-intensive paired data annotation, limited generalizability, and performance degradation in low-level computer vision tasks. In this work, we introduce an innovative Unsupervised Exposure Correction (UEC) method that eliminates the need for manual annotations, offers improved generalizability, and enhances performance in low-level downstream tasks. Our model is trained using freely available paired data from an emulated Image Signal Processing (ISP) pipeline. This approach does not need expensive manual annotations, thereby minimizing individual style biases from the annotation and consequently improving its generalizability. Furthermore, we present a large-scale Radiometry Correction Dataset, specifically designed to emphasize exposure variations, to facilitate unsupervised learning. In addition, we develop a transformation function that preserves image details and outperforms state-of-the-art supervised methods [12], while utilizing only 0.01% of their parameters. Our work further investigates the broader impact of exposure correction on downstream tasks, including edge detection, demonstrating its effectiveness in mitigating the adverse effects of poor exposure on low-level features. The source code and dataset are publicly available at https://github.com/BeyondHeaven/uec_code.

Deep learning classifiers face significant challenges when dealing with heterogeneous multi-modal and multi-organ biomedical datasets. The low-level feature distinguishability limited to imaging-modality hinders the classifiers' ability to learn high-level semantic relationships, resulting in sub-optimal performance. To address this issue, image augmentation strategies are employed as regularization techniques. While additive noise input during network training is a well-established augmentation as regularization method, modern pipelines often favor more robust techniques such as dropout and weight decay. This preference stems from the observation that combining these established techniques with noise input can adversely affect model performance. In this study, we propose a novel pretraining pipeline that learns to generate conditional noise mask specifically tailored to improve performance on multi-modal and multi-organ datasets. As a reinforcement learning algorithm, our approach employs a dual-component system comprising a very light-weight policy network that learns to sample conditional noise using a differentiable beta distribution as well as a classifier network. The policy network is trained using the reinforce algorithm to generate image-specific noise masks that regularize the classifier during pretraining. A key aspect is that the policy network's role is limited to obtaining an intermediate (or heated) model before fine-tuning. During inference, the policy network is omitted, allowing direct comparison between the baseline and noise-regularized models. We conducted experiments and related analyses on RadImageNet datasets. Results demonstrate that fine-tuning the intermediate models consistently outperforms conventional training algorithms on both classification and generalization to unseen concept tasks.

Because anomalous samples cannot be used for training, many anomaly detection and localization methods use pre-trained networks and non-parametric modeling to estimate encoded feature distribution. However, these methods neglect the impact of position and neighborhood information on the distribution of normal features. To overcome this, we propose a new algorithm, PNI, which estimates the normal distribution using conditional probability given neighborhood features, modeled with a multi-layer perceptron network. Moreover, position information is utilized by creating a histogram of representative features at each position. Instead of simply resizing the anomaly map, the proposed method employs an additional refine network trained on synthetic anomaly images to better interpolate and account for the shape and edge of the input image. We conducted experiments on the MVTec AD benchmark dataset and achieved state-of-the-art performance, with 99.56\% and 98.98\% AUROC scores in anomaly detection and localization, respectively.

The success of Deep Neural Network (DNN) models significantly depends on the quality of provided annotations. In medical image segmentation, for example, having multiple expert annotations for each data point is common to minimize subjective annotation bias. Then, the goal of estimation is to filter out the label noise and recover the ground-truth masks, which are not explicitly given. This paper proposes a probabilistic model for noisy observations that allows us to build a confident classification and segmentation models. To accomplish it, we explicitly model label noise and introduce a new information-based regularization that pushes the network to recover the ground-truth labels. In addition, for segmentation task we adjust the loss function by prioritizing learning in high-confidence regions where all the annotators agree on labeling. We evaluate the proposed method on a series of classification tasks such as noisy versions of MNIST, CIFAR-10, Fashion-MNIST datasets as well as CIFAR-10N, which is real-world dataset with noisy human annotations. Additionally, for segmentation task, we consider several medical imaging datasets, such as, LIDC and RIGA that reflect real-world inter-variability among multiple annotators. Our experiments show that our algorithm outperforms state-of-the-art solutions for the considered classification and segmentation problems.

Regularization of inverse problems is of paramount importance in computational imaging. The ability of neural networks to learn efficient image representations has been recently exploited to design powerful data-driven regularizers. While state-of-the-art plug-and-play (PnP) methods rely on an implicit regularization provided by neural denoisers, alternative Bayesian approaches consider Maximum A Posteriori (MAP) estimation in the latent space of a generative model, thus with an explicit regularization. However, state-of-the-art deep generative models require a huge amount of training data compared to denoisers. Besides, their complexity hampers the optimization involved in latent MAP derivation. In this work, we first propose to use compressive autoencoders instead. These networks, which can be seen as variational autoencoders with a flexible latent prior, are smaller and easier to train than state-of-the-art generative models. As a second contribution, we introduce the Variational Bayes Latent Estimation (VBLE) algorithm, which performs latent estimation within the framework of variational inference. Thanks to a simple yet efficient parameterization of the variational posterior, VBLE allows for fast and easy (approximate) posterior sampling. Experimental results on image datasets BSD and FFHQ demonstrate that VBLE reaches similar performance as state-of-the-art PnP methods, while being able to quantify uncertainties significantly faster than other existing posterior sampling techniques. The code associated to this paper is available in https://github.com/MaudBqrd/VBLE.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Accurate segmentation of Multiple Sclerosis (MS) lesions in longitudinal MRI scans is crucial for monitoring disease progression and treatment efficacy. Although changes across time are taken into account when assessing images in clinical practice, most existing deep learning methods treat scans from different timepoints separately. Among studies utilizing longitudinal images, a simple channel-wise concatenation is the primary albeit suboptimal method employed to integrate timepoints. We introduce a novel approach that explicitly incorporates temporal differences between baseline and follow-up scans through a unique architectural inductive bias called Difference Weighting Block. It merges features from two timepoints, emphasizing changes between scans. We achieve superior scores in lesion segmentation (Dice Score, Hausdorff distance) as well as lesion detection (lesion-level F_1 score) as compared to state-of-the-art longitudinal and single timepoint models across two datasets. Our code is made publicly available at www.github.com/MIC-DKFZ/Longitudinal-Difference-Weighting.

Collective insights from a group of experts have always proven to outperform an individual's best diagnostic for clinical tasks. For the task of medical image segmentation, existing research on AI-based alternatives focuses more on developing models that can imitate the best individual rather than harnessing the power of expert groups. In this paper, we introduce a single diffusion model-based approach that produces multiple plausible outputs by learning a distribution over group insights. Our proposed model generates a distribution of segmentation masks by leveraging the inherent stochastic sampling process of diffusion using only minimal additional learning. We demonstrate on three different medical image modalities- CT, ultrasound, and MRI that our model is capable of producing several possible variants while capturing the frequencies of their occurrences. Comprehensive results show that our proposed approach outperforms existing state-of-the-art ambiguous segmentation networks in terms of accuracy while preserving naturally occurring variation. We also propose a new metric to evaluate the diversity as well as the accuracy of segmentation predictions that aligns with the interest of clinical practice of collective insights.