Physics-Guided Synthetic High-Frequency Ultrasound Generation for Skin Layer Segmentation

Ultra-low-field (ULF) MRI offers portable and accessible neuroimaging but suffers from reduced signal-to-noise ratio and limited spatial resolution compared to high-field (HF) systems. Acquiring paired ULF-HF data for supervised enhancement is often difficult, particularly in resource-limited settings. We introduce ULF-Synth, a framework that combines: (i) acquisition-based synthesis of realistic ULF images from HF volumes to create large-scale paired training data, (ii) a spatial-frequency domain objective that prioritizes recovery of high-frequency anatomical detail. This formulation is architecture-agnostic, consistently improving structural similarity and perceptual fidelity across encoder-decoder, adversarial, and diffusion-based translation models. When trained exclusively on synthetic data, the resulting models generalize effectively to real 64mT ULF acquisitions, improving downstream multiclass brain segmentation and achieving higher radiologist preference and diagnostic acceptability in a blinded reader study. These findings demonstrate that synthetic paired supervision provides a practical and scalable pathway for enhancing ULF MRI without requiring real paired acquisitions. Code, Models and Dataset: https://github.com/toufiqmusah/ULF-Synth

Prenatal ultrasound imaging is key for assessing fetal health, but AI progress is limited by scarce, privacy-restricted, and hard-to-annotate datasets. We propose a high-resolution fetal ultrasound synthesis framework based on the EDM2 diffusion architecture, trained on multiple public datasets to generate 512x512 images across six anatomical classes. Our method achieved improved image quality with lower FID scores and enhanced downstream fetal plane classification, reaching 93.36% ensemble accuracy after fine-tuning, surpassing real-data-only training. Clinical evaluation by an experienced fetal ultrasound specialist (10+ years) on 100 images yielded a mean realism score of 2.67/5, with real images rated higher than synthetic. Artefacts included smoothing, speckle irregularities, and anatomical inconsistencies. Code, data, models and other resources to reproduce this work are available at https://github.com/xfetus/fetal-ultrasound-edm2.

Conditional diffusion models can generate anatomically plausible medical ultrasound (US) images, but anatomical plausibility alone does not ensure realistic B-mode appearance. Most US pipelines adapt standard generative architectures and condition them on anatomical masks, or use guidance mechanisms that reinforce the same anatomical signal. However, B-mode US images are shaped by acquisition-dependent properties such as speckle texture, tissue contrast, and attenuation. Using a frozen US foundation model, we show that standard conditional diffusion baselines remain separated from real images in representation space. In this work, we propose Feature-Space Candidate Guidance (FSCG), a training-free sampling strategy to reduce this gap. At sampling time, FSCG applies local k-NN feature correction and selects the best of multiple stochastic candidates according to their feature-space energy. In this way, the mask defines the anatomy, while FSCG steers samples toward the real US domain. Across three different datasets, FSCG reduces average FID64 by 56%, FID192 by 57%, and nearest-neighbour feature distance by 47% over standard conditional diffusion sampling, outperforming alternative inference-time guidance baselines. The results suggest that domain-aware feature representations can reveal and reduce realism gaps in medical diffusion synthesis without retraining the generator. Our code is available at https://github.com/marinadominguez/FSCG.