# Pathology-Aware Adaptive Watermarking for Text-Driven Medical Image Synthesis

arXiv: https://arxiv.org/abs/2503.08346 · HTML: https://mlsanity.com/paper/2503.08346/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 25 of its 36 references that are in the map.
- First posted on arXiv 11 Mar 2025.

## Placed in

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

## Builds on (most cited first, 25 of 25)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [Hierarchical Text-Conditional Image Generation with CLIP Latents](https://mlsanity.com/paper/2204.06125/) (2022)
- [GLIDE: Towards Photorealistic Image Generation and Editing with Text-Guided Diffusion Models](https://mlsanity.com/paper/2112.10741/) (2021)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [HiDDeN: Hiding Data With Deep Networks](https://mlsanity.com/paper/1807.09937/) (2018)
- [The Stable Signature: Rooting Watermarks in Latent Diffusion Models](https://mlsanity.com/paper/2303.15435/) (2023)
- [Effective Data Augmentation With Diffusion Models](https://mlsanity.com/paper/2302.07944/) (2023)
- [Gaussian Shading: Provable Performance-Lossless Image Watermarking for Diffusion Models](https://mlsanity.com/paper/2404.04956/) (2024)
- [TorchXRayVision: A library of chest X-ray datasets and models](https://mlsanity.com/paper/2111.00595/) (2021)
- [EditGuard: Versatile Image Watermarking for Tamper Localization and Copyright Protection](https://mlsanity.com/paper/2312.08883/) (2023)
- [Watermarking Images in Self-Supervised Latent Spaces](https://mlsanity.com/paper/2112.09581/) (2021)
- [RingID: Rethinking Tree-Ring Watermarking for Enhanced Multi-Key Identification](https://mlsanity.com/paper/2404.14055/) (2024)
- [LLM-CXR: Instruction-Finetuned LLM for CXR Image Understanding and Generation](https://mlsanity.com/paper/2305.11490/) (2023)
- [Watermark Anything with Localized Messages](https://mlsanity.com/paper/2411.07231/) (2024)
- [PathLDM: Text conditioned Latent Diffusion Model for Histopathology](https://mlsanity.com/paper/2309.00748/) (2023)
- [A Loss Function for Generative Neural Networks Based on Watson's Perceptual Model](https://mlsanity.com/paper/2006.15057/) (2020)
- [A Benchmark of Ocular Disease Intelligent Recognition: One Shot for Multi-disease Detection](https://mlsanity.com/paper/2102.07978/) (2021)
- [CT-GAN: Malicious Tampering of 3D Medical Imagery using Deep Learning](https://mlsanity.com/paper/1901.03597/) (2019)
- [Open-Vocabulary Attention Maps with Token Optimization for Semantic Segmentation in Diffusion Models](https://mlsanity.com/paper/2403.14291/) (2024)
- [WateRF: Robust Watermarks in Radiance Fields for Protection of Copyrights](https://mlsanity.com/paper/2405.02066/) (2024)
- [Advancing Text-Driven Chest X-Ray Generation with Policy-Based Reinforcement Learning](https://mlsanity.com/paper/2403.06516/) (2024)
- [MEDDAP: Medical Dataset Enhancement via Diversified Augmentation Pipeline](https://mlsanity.com/paper/2403.16335/) (2024)

## Built on by (most cited first, 1 of 1)

- [PT-Mark: Invisible Watermarking for Text-to-image Diffusion Models via Semantic-aware Pivotal Tuning](https://mlsanity.com/paper/2504.10853/) (2025)

## Abstract (arXiv)

As recent text-conditioned diffusion models have enabled the generation of high-quality images, concerns over their potential misuse have also grown. This issue is critical in the medical domain, where text-conditioned generated medical images could enable insurance fraud or falsified records, highlighting the urgent need for reliable safeguards against unethical use. While watermarking techniques have emerged as a promising solution in general image domains, their direct application to medical imaging presents significant challenges. A key challenge is preserving fine-grained disease manifestations, as even minor distortions from a watermark may lead to clinical misinterpretation, which compromises diagnostic integrity. To overcome this gap, we present MedSign, a deep learning-based watermarking framework specifically designed for text-to-medical image synthesis, which preserves pathologically significant regions by adaptively adjusting watermark strength. Specifically, we generate a pathology localization map using cross-attention between medical text tokens and the diffusion denoising network, aggregating token-wise attention across layers, heads, and time steps. Leveraging this map, we optimize the LDM decoder to incorporate watermarking during image synthesis, ensuring cohesive integration while minimizing interference in diagnostically critical regions. Experimental results show that our MedSign preserves diagnostic integrity while ensuring watermark robustness, achieving state-of-the-art performance in image quality and detection accuracy on MIMIC-CXR and OIA-ODIR datasets.