# Recognizing Pneumonia in Real-World Chest X-rays with a Classifier Trained with Images Synthetically Generated by Nano Banana

arXiv: https://arxiv.org/abs/2512.00428 · HTML: https://mlsanity.com/paper/2512.00428/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 4 of its 11 references that are in the map.
- First posted on arXiv 29 Nov 2025.

## Builds on (most cited first, 4 of 4)

- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [Shortcut Learning in Deep Neural Networks](https://mlsanity.com/paper/2004.07780/) (2020)
- [Improving Performance, Robustness, and Fairness of Radiographic AI Models with Finely-Controllable Synthetic Data](https://mlsanity.com/paper/2508.16783/) (2025)

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

- [Can Unified Generation and Understanding Models Maintain Semantic Equivalence Across Different Output Modalities?](https://mlsanity.com/paper/2602.23711/) (2026)

## Abstract (arXiv)

We trained a classifier with synthetic chest X-ray (CXR) images generated by Nano Banana, the latest AI model for image generation and editing, released by Google. When directly applied to real-world CXRs having only been trained with synthetic data, the classifier achieved an AUROC of 0.923 (95% CI: 0.919 - 0.927), and an AUPR of 0.900 (95% CI: 0.894 - 0.907) in recognizing pneumonia in the 2018 RSNA Pneumonia Detection dataset (14,863 CXRs), and an AUROC of 0.824 (95% CI: 0.810 - 0.836), and an AUPR of 0.913 (95% CI: 0.904 - 0.922) in the Chest X-Ray dataset (5,856 CXRs). These external validation results on real-world data demonstrate the feasibility of this approach and suggest potential for synthetic data in medical AI development. Nonetheless, several limitations remain at present, including challenges in prompt design for controlling the diversity of synthetic CXR data and the requirement for post-processing to ensure alignment with real-world data. However, the growing sophistication and accessibility of medical intelligence will necessitate substantial validation, regulatory approval, and ethical oversight prior to clinical translation.