DeBoneDiT: Depth-Driven Conditional Bridge Diffusion Transformers for Bone Suppression in Chest X-Ray Images

Bone overlap can obscure abnormalities in chest radiographs, while scarce paired training data limit supervised bone suppression. We address this challenge with a digitally reconstructed radiograph (DRR) framework that converts chest computed tomography (CT) into paired supervision for component suppression. A novel bone segmentation algorithm enables CT decomposition into bone, non-lung soft-tissue, and lung components, which are projected separately. Their weighted combination yields synthetic radiographs with pixel-registered component images that sum exactly to the full DRR. Models trained on these data suppress bone or lung components by predicting the target component and recovering the remainder by subtraction, transferring to real radiographs without real paired training data. As an extension, their outputs on real radiographs provide target domains for unpaired, component-wise DRR translation, reducing the appearance gap while retaining anatomical details. Across multiple public datasets, downstream detection experiments demonstrate the utility of bone suppression, with gains concentrated on abnormalities with substantial bone overlap. Compared with open-source DRR engines applied to the same CTs, our unmodified DRRs achieve comparable realism and preservation of label-relevant anatomy, while translated DRRs achieve the best Fréchet inception distance (FID), lung-field sharpness, and agreement with source-CT anatomy among the evaluated methods. Models and inference code: https://huggingface.co/qureaiorg/bone-suppression ; Translated projections: https://huggingface.co/datasets/qureaiorg/ct2xr-projections.

Deep learning-based automated diagnosis of lung cancer has emerged as a crucial advancement that enables healthcare professionals to detect and initiate treatment earlier. However, these models require extensive training datasets with diverse case-specific properties. High-quality annotated data is particularly challenging to obtain, especially for cases with subtle pulmonary nodules that are difficult to detect even for experienced radiologists. This scarcity of well-labeled datasets can limit model performance and generalization across different patient populations. Digitally reconstructed radiographs (DRR) using CT-Scan to generate synthetic frontal chest X-rays with artificially inserted lung nodules offers one potential solution. However, this approach suffers from significant image quality degradation, particularly in the form of blurred anatomical features and loss of fine lung field structures. To overcome this, we introduce DiffusionXRay, a novel image restoration pipeline for Chest X-ray images that synergistically leverages denoising diffusion probabilistic models (DDPMs) and generative adversarial networks (GANs). DiffusionXRay incorporates a unique two-stage training process: First, we investigate two independent approaches, DDPM-LQ and GAN-based MUNIT-LQ, to generate low-quality CXRs, addressing the challenge of training data scarcity, posing this as a style transfer problem. Subsequently, we train a DDPM-based model on paired low-quality and high-quality images, enabling it to learn the nuances of X-ray image restoration. Our method demonstrates promising results in enhancing image clarity, contrast, and overall diagnostic value of chest X-rays while preserving subtle yet clinically significant artifacts, validated by both quantitative metrics and expert radiological assessment.

Latent Diffusion Models have shown remarkable results in text-guided image synthesis in recent years. In the domain of natural (RGB) images, recent works have shown that such models can be adapted to various vision-language downstream tasks with little to no supervision involved. On the contrary, text-to-image Latent Diffusion Models remain relatively underexplored in the field of medical imaging, primarily due to limited data availability (e.g., due to privacy concerns). In this work, focusing on the chest X-ray modality, we first demonstrate that a standard text-conditioned Latent Diffusion Model has not learned to align clinically relevant information in free-text radiology reports with the corresponding areas of the given scan. Then, to alleviate this issue, we propose a fine-tuning framework to improve multi-modal alignment in a pre-trained model such that it can be efficiently repurposed for downstream tasks such as phrase grounding. Our method sets a new state-of-the-art on a standard benchmark dataset (MS-CXR), while also exhibiting robust performance on out-of-distribution data (VinDr-CXR). We further validate our approach through a pilot qualitative study and an experiment on grounded disease classification. Our code will be made publicly available at https://github.com/vios-s.