# A Recycling Training Strategy for Medical Image Segmentation with Diffusion Denoising Models

arXiv: https://arxiv.org/abs/2308.16355 · HTML: https://mlsanity.com/paper/2308.16355/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 52 of its 59 references that are in the map.
- First posted on arXiv 30 Aug 2023.

## Placed in

- Diffusion models / [Medical imaging and segmentation](https://mlsanity.com/diffusion/medical-imaging-and-segmentation/)

## Builds on (most cited first, 30 of 52)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [Denoising Diffusion Implicit Models](https://mlsanity.com/paper/2010.02502/) (2020)
- [Score-Based Generative Modeling through Stochastic Differential Equations](https://mlsanity.com/paper/2011.13456/) (2020)
- [Diffusion Models Beat GANs on Image Synthesis](https://mlsanity.com/paper/2105.05233/) (2021)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Deep Unsupervised Learning using Nonequilibrium Thermodynamics](https://mlsanity.com/paper/1503.03585/) (2015)
- [Hierarchical Text-Conditional Image Generation with CLIP Latents](https://mlsanity.com/paper/2204.06125/) (2022)
- [Classifier-Free Diffusion Guidance](https://mlsanity.com/paper/2207.12598/) (2022)
- [Generative Adversarial Networks](https://mlsanity.com/paper/2203.00667/) (2022)
- [Generative Modeling by Estimating Gradients of the Data Distribution](https://mlsanity.com/paper/1907.05600/) (2019)
- [Improved Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2102.09672/) (2021)
- [Structured Denoising Diffusion Models in Discrete State-Spaces](https://mlsanity.com/paper/2107.03006/) (2021)
- [Variational Diffusion Models](https://mlsanity.com/paper/2107.00630/) (2021)
- [Improved Techniques for Training Score-Based Generative Models](https://mlsanity.com/paper/2006.09011/) (2020)
- [Diffusion-LM Improves Controllable Text Generation](https://mlsanity.com/paper/2205.14217/) (2022)
- [Vector Quantized Diffusion Model for Text-to-Image Synthesis](https://mlsanity.com/paper/2111.14822/) (2021)
- [Pseudo Numerical Methods for Diffusion Models on Manifolds](https://mlsanity.com/paper/2202.09778/) (2022)
- [Argmax Flows and Multinomial Diffusion: Learning Categorical Distributions](https://mlsanity.com/paper/2102.05379/) (2021)
- [The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification](https://mlsanity.com/paper/2107.02314/) (2021)
- [Analog Bits: Generating Discrete Data using Diffusion Models with Self-Conditioning](https://mlsanity.com/paper/2208.04202/) (2022)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [SegDiff: Image Segmentation with Diffusion Probabilistic Models](https://mlsanity.com/paper/2112.00390/) (2021)
- [Diffusion Models for Medical Image Analysis: A Comprehensive Survey](https://mlsanity.com/paper/2211.07804/) (2022)
- [Brain Imaging Generation with Latent Diffusion Models](https://mlsanity.com/paper/2209.07162/) (2022)
- [Diffusion Models for Medical Anomaly Detection](https://mlsanity.com/paper/2203.04306/) (2022)
- [Diffusion Models for Implicit Image Segmentation Ensembles](https://mlsanity.com/paper/2112.03145/) (2021)
- [SSD-LM: Semi-autoregressive Simplex-based Diffusion Language Model for Text Generation and Modular Control](https://mlsanity.com/paper/2210.17432/) (2022)
- [MedSegDiff: Medical Image Segmentation with Diffusion Probabilistic Model](https://mlsanity.com/paper/2211.00611/) (2022)
- [Medical Image Segmentation Using Deep Learning: A Survey](https://mlsanity.com/paper/2009.13120/) (2020)

## Built on by (most cited first, 5 of 5)

- [A Comprehensive Survey of Foundation Models in Medicine](https://mlsanity.com/paper/2406.10729/) (2024)
- [Patient-specific radiomic feature selection with reconstructed healthy persona of knee MR images](https://mlsanity.com/paper/2503.13131/) (2025)
- [ResEnsemble-DDPM: Residual Denoising Diffusion Probabilistic Models for Ensemble Learning](https://mlsanity.com/paper/2312.01682/) (2023)
- [Flow Matching-enabled Test-Time Refinement for Unsupervised Cardiac MR Registration](https://mlsanity.com/paper/2603.01073/) (2026)
- [Rethinking Diffusion Segmentation: When Does It Rely on Its Noisy State, and Does Diffusion Matter?](https://mlsanity.com/paper/2609.23967/) (2026)

## Abstract (arXiv)

Denoising diffusion models have found applications in image segmentation by generating segmented masks conditioned on images. Existing studies predominantly focus on adjusting model architecture or improving inference, such as test-time sampling strategies. In this work, we focus on improving the training strategy and propose a novel recycling method. During each training step, a segmentation mask is first predicted given an image and a random noise. This predicted mask, which replaces the conventional ground truth mask, is used for denoising task during training. This approach can be interpreted as aligning the training strategy with inference by eliminating the dependence on ground truth masks for generating noisy samples. Our proposed method significantly outperforms standard diffusion training, self-conditioning, and existing recycling strategies across multiple medical imaging data sets: muscle ultrasound, abdominal CT, prostate MR, and brain MR. This holds for two widely adopted sampling strategies: denoising diffusion probabilistic model and denoising diffusion implicit model. Importantly, existing diffusion models often display a declining or unstable performance during inference, whereas our novel recycling consistently enhances or maintains performance. We show that, under a fair comparison with the same network architectures and computing budget, the proposed recycling-based diffusion models achieved on-par performance with non-diffusion-based supervised training. By ensembling the proposed diffusion and the non-diffusion models, significant improvements to the non-diffusion models have been observed across all applications, demonstrating the value of this novel training method. This paper summarizes these quantitative results and discusses their values, with a fully reproducible JAX-based implementation, released at https://github.com/mathpluscode/ImgX-DiffSeg.