# X-ray Insights Unleashed: Pioneering the Enhancement of Multi-Label Long-Tail Data

arXiv: https://arxiv.org/abs/2512.20980 · HTML: https://mlsanity.com/paper/2512.20980/

## 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 19 of its 39 references that are in the map.
- First posted on arXiv 24 Dec 2025.

## Placed in

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

## Builds on (most cited first, 19 of 19)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [mixup: Beyond Empirical Risk Minimization](https://mlsanity.com/paper/1710.09412/) (2017)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Class-Balanced Loss Based on Effective Number of Samples](https://mlsanity.com/paper/1901.05555/) (2019)
- [LVIS: A Dataset for Large Vocabulary Instance Segmentation](https://mlsanity.com/paper/1908.03195/) (2019)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [Decoupling Representation and Classifier for Long-Tailed Recognition](https://mlsanity.com/paper/1910.09217/) (2019)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [MViTv2: Improved Multiscale Vision Transformers for Classification and Detection](https://mlsanity.com/paper/2112.01526/) (2021)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [Overcoming Classifier Imbalance for Long-tail Object Detection with Balanced Group Softmax](https://mlsanity.com/paper/2006.10408/) (2020)
- [Auto-Encoding Knowledge Graph for Unsupervised Medical Report Generation](https://mlsanity.com/paper/2111.04318/) (2021)
- [Balanced-MixUp for Highly Imbalanced Medical Image Classification](https://mlsanity.com/paper/2109.09850/) (2021)
- [Image Synthesis with Disentangled Attributes for Chest X-Ray Nodule Augmentation and Detection](https://mlsanity.com/paper/2207.09389/) (2022)

## Abstract (arXiv)

Long-tailed pulmonary anomalies in chest radiography present formidable diagnostic challenges. Despite the recent strides in diffusion-based methods for enhancing the representation of tailed lesions, the paucity of rare lesion exemplars curtails the generative capabilities of these approaches, thereby leaving the diagnostic precision less than optimal. In this paper, we propose a novel data synthesis pipeline designed to augment tail lesions utilizing a copious supply of conventional normal X-rays. Specifically, a sufficient quantity of normal samples is amassed to train a diffusion model capable of generating normal X-ray images. This pre-trained diffusion model is subsequently utilized to inpaint the head lesions present in the diseased X-rays, thereby preserving the tail classes as augmented training data. Additionally, we propose the integration of a Large Language Model Knowledge Guidance (LKG) module alongside a Progressive Incremental Learning (PIL) strategy to stabilize the inpainting fine-tuning process. Comprehensive evaluations conducted on the public lung datasets MIMIC and CheXpert demonstrate that the proposed method sets a new benchmark in performance.