# Evaluating and Improving the Effectiveness of Synthetic Chest X-Rays for Medical Image Analysis

arXiv: https://arxiv.org/abs/2411.18602 · HTML: https://mlsanity.com/paper/2411.18602/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 13 of its 24 references that are in the map.
- First posted on arXiv 27 Nov 2024.

## Builds on (most cited first, 13 of 13)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [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)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [Adding Conditional Control to Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.05543/) (2023)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Preference Ranking Optimization for Human Alignment](https://mlsanity.com/paper/2306.17492/) (2023)
- [Diffusion Models for Medical Image Analysis: A Comprehensive Survey](https://mlsanity.com/paper/2211.07804/) (2022)
- [GAN-based Synthetic Medical Image Augmentation for increased CNN Performance in Liver Lesion Classification](https://mlsanity.com/paper/1803.01229/) (2018)
- [Multi-Granularity Cross-modal Alignment for Generalized Medical Visual Representation Learning](https://mlsanity.com/paper/2210.06044/) (2022)
- [Medical Image Synthesis for Data Augmentation and Anonymization using Generative Adversarial Networks](https://mlsanity.com/paper/1807.10225/) (2018)
- [Derm-T2IM: Harnessing Synthetic Skin Lesion Data via Stable Diffusion Models for Enhanced Skin Disease Classification using ViT and CNN](https://mlsanity.com/paper/2401.05159/) (2024)

## Built on by (most cited first, 3 of 3)

- [Tokenizer-Generator Coupling in Medical Image Generation](https://mlsanity.com/paper/2608.07713/) (2026)
- [AURAD: Anatomy-Pathology Unified Radiology Synthesis with Progressive Representations](https://mlsanity.com/paper/2509.04819/) (2025)
- [SALIENT: Frequency-Aware Paired Diffusion for Controllable Long-Tail CT Detection](https://mlsanity.com/paper/2602.23447/) (2026)

## Abstract (arXiv)

Purpose: To explore best-practice approaches for generating synthetic chest X-ray images and augmenting medical imaging datasets to optimize the performance of deep learning models in downstream tasks like classification and segmentation. Materials and Methods: We utilized a latent diffusion model to condition the generation of synthetic chest X-rays on text prompts and/or segmentation masks. We explored methods like using a proxy model and using radiologist feedback to improve the quality of synthetic data. These synthetic images were then generated from relevant disease information or geometrically transformed segmentation masks and added to ground truth training set images from the CheXpert, CANDID-PTX, SIIM, and RSNA Pneumonia datasets to measure improvements in classification and segmentation model performance on the test sets. F1 and Dice scores were used to evaluate classification and segmentation respectively. One-tailed t-tests with Bonferroni correction assessed the statistical significance of performance improvements with synthetic data. Results: Across all experiments, the synthetic data we generated resulted in a maximum mean classification F1 score improvement of 0.150453 (CI: 0.099108-0.201798; P=0.0031) compared to using only real data. For segmentation, the maximum Dice score improvement was 0.14575 (CI: 0.108267-0.183233; P=0.0064). Conclusion: Best practices for generating synthetic chest X-ray images for downstream tasks include conditioning on single-disease labels or geometrically transformed segmentation masks, as well as potentially using proxy modeling for fine-tuning such generations.