Retrieval-Augmented Anatomical Guidance for Text-to-CT Generation

Generative models for volumetric medical images have found many applications in medical imaging, ranging from data augmentation to serving as priors for inverse problems. For these applications, generating high-resolution 3D images with strong controllability is essential but remains highly challenging. Existing approaches typically control generation either through radiology reports used as text prompts or through full image segmentation. While text-based prompting is flexible, it provides limited spatial control over the location, shape, and boundary of abnormalities. In contrast, segmentation-based methods receive precise spatial guidance but are restrictive in requiring full-organ annotations. In this work, we propose a flexible multimodal framework for controllable volumetric image generation that supports input from radiology reports and segmentation prompts (both optional). Our approach allows users to provide segmentation of a specific anatomy or abnormality without requiring full-organ annotations. The semantic meaning of the segmentation mask is specified through an accompanying text description, resulting in a highly flexible and scalable conditioning mechanism. We develop a memory-efficient architecture based on a modified diffusion transformer that jointly processes image and segmentation tokens. The model further incorporates gated attention to effectively attend to long radiology reports. Experiments demonstrate that our method achieves state-of-the-art perceptual and semantic scores (e.g., 24% relative improvement in mean FID), generates high-resolution anatomically consistent CT volumes, and improves data efficiency when used for data augmentation. Radiologists' evaluation further confirms strong alignment between generated and real medical images.

Generating semantically controllable 3D CT volumes from radiology reports requires more than a rich text encoder, it requires vision-language alignment grounded in volumetric space. Existing Text-to-CT approaches condition generation on encoders pretrained with language only or 2D vision-language objectives, providing conditioning signals that are linguistically expressive but volumetrically blind. We argue this is a structural limitation: the quality of 3D vision-language alignment, not the richness of the text encoder, is the primary bottleneck for semantic controllability in volumetric diffusion models. To address this, we propose a generation-oriented 3D-CLIP encoder trained with structured hard negatives that operate exclusively at the text level. This design increases contrastive difficulty without any additional 3D memory cost, overcoming the small-batch constraints inherent to volumetric encoders. The resulting encoder conditions a fully end-to-end latent diffusion model that operates directly in 3D latent space, eliminating the spatial artifacts and cross-slice inconsistencies introduced by super-resolution pipelines. Through systematic ablations, we establish a clear empirical link between grounding quality and downstream generative controllability. Evaluated on CT-RATE across 18 pathological conditions, our method achieves state-of-the-art performance on both image fidelity and factual correctness, while requiring less inference time and GPU memory than all competing methods. Code is at https://github.com/danielemolino/Text2CT.

Diffusion probabilistic models have demonstrated significant potential in generating high-quality, realistic medical images, providing a promising solution to the persistent challenge of data scarcity in the medical field. Nevertheless, producing 3D medical volumes with anatomically consistent structures under multimodal conditions remains a complex and unresolved problem. We introduce Sketch2CT, a multimodal diffusion framework for structure-aware 3D medical volume generation, jointly guided by a user-provided 2D sketch and a textual description that captures 3D geometric semantics. The framework initially generates 3D segmentation masks of the target organ from random noise, conditioned on both modalities. To effectively align and fuse these inputs, we propose two key modules that refine sketch features with localized textual cues and integrate global sketch-text representations. Built upon a capsule-attention backbone, these modules leverage the complementary strengths of sketches and text to produce anatomically accurate organ shapes. The synthesized segmentation masks subsequently guide a latent diffusion model for 3D CT volume synthesis, enabling realistic reconstruction of organ appearances that are consistent with user-defined sketches and descriptions. Extensive experiments on public CT datasets demonstrate that Sketch2CT achieves superior performance in generating multimodal medical volumes. Its controllable, low-cost generation pipeline enables principled, efficient augmentation of medical datasets. Code is available at https://github.com/adlsn/Sketch2CT.