# Expert Validation of Synthetic Cervical Spine Radiographs Generated with a Denoising Diffusion Probabilistic Model

arXiv: https://arxiv.org/abs/2510.22166 · HTML: https://mlsanity.com/paper/2510.22166/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 6 of its 30 references that are in the map.
- First posted on arXiv 25 Oct 2025.

## Placed in

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

## Builds on (most cited first, 6 of 6)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [Diffusion Models Beat GANs on Image Synthesis](https://mlsanity.com/paper/2105.05233/) (2021)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [A Multifaceted Benchmarking of Synthetic Electronic Health Record Generation Models](https://mlsanity.com/paper/2208.01230/) (2022)
- [Trustworthy Text-to-Image Diffusion Models: A Timely and Focused Survey](https://mlsanity.com/paper/2409.18214/) (2024)

## Abstract (arXiv)

Machine learning in neurosurgery is limited by challenges in assembling large, high-quality imaging datasets. Synthetic data offers a scalable, privacy-preserving solution. We evaluated the feasibility of generating realistic lateral cervical spine radiographs using a denoising diffusion probabilistic model (DDPM) trained on 4,963 images from the Cervical Spine X-ray Atlas. Model performance was monitored via training/validation loss and Frechet inception distance, and synthetic image quality was assessed in a blinded "clinical Turing test" with six neuroradiologists and two spine-fellowship trained neurosurgeons. Experts reviewed 50 quartets containing one real and three synthetic images, identifying the real image and rating realism on a 4-point Likert scale. Experts correctly identified the real image in 29% of trials (Fleiss' kappa=0.061). Mean realism scores were comparable between real (3.323) and synthetic images (3.228, 3.258, and 3.320; p=0.383, 0.471, 1.000). Nearest-neighbor analysis found no evidence of memorization. We also provide a dataset of 20,063 synthetic radiographs. These results demonstrate that DDPM-generated cervical spine X-rays are statistically indistinguishable in realism and quality from real clinical images, offering a novel approach to creating large-scale neuroimaging datasets for ML applications in landmarking, segmentation, and classification.