# 2D Versus 3D Diffusion for In Silico Training of Interventional X-ray AI Models

arXiv: https://arxiv.org/abs/2606.21414 · HTML: https://mlsanity.com/paper/2606.21414/

## 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 15 of its 24 references that are in the map.
- First posted on arXiv 19 Jun 2026.

## Placed in

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

## Builds on (most cited first, 15 of 15)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [MAISI: Medical AI for Synthetic Imaging](https://mlsanity.com/paper/2409.11169/) (2024)
- [Anatomically-Controllable Medical Image Generation with Segmentation-Guided Diffusion Models](https://mlsanity.com/paper/2402.05210/) (2024)
- [DeepDRR -- A Catalyst for Machine Learning in Fluoroscopy-guided Procedures](https://mlsanity.com/paper/1803.08606/) (2018)
- [Cascaded Latent Diffusion Models for High-Resolution Chest X-ray Synthesis](https://mlsanity.com/paper/2303.11224/) (2023)
- [Automatic Annotation of Hip Anatomy in Fluoroscopy for Robust and Efficient 2D/3D Registration](https://mlsanity.com/paper/1911.07042/) (2019)
- [X-ray-transform Invariant Anatomical Landmark Detection for Pelvic Trauma Surgery](https://mlsanity.com/paper/1803.08608/) (2018)
- [Chest-Diffusion: A Light-Weight Text-to-Image Model for Report-to-CXR Generation](https://mlsanity.com/paper/2407.00752/) (2024)
- [Pelphix: Surgical Phase Recognition from X-ray Images in Percutaneous Pelvic Fixation](https://mlsanity.com/paper/2304.09285/) (2023)
- [FluoroSAM: A Language-promptable Foundation Model for Flexible X-ray Image Segmentation](https://mlsanity.com/paper/2403.08059/) (2024)
- [Towards Virtual Clinical Trials of Radiology AI with Conditional Generative Modeling](https://mlsanity.com/paper/2502.09688/) (2025)
- [DRR4Covid: Learning Automated COVID-19 Infection Segmentation from Digitally Reconstructed Radiographs](https://mlsanity.com/paper/2008.11478/) (2020)
- [Intelligent Control of Robotic X-ray Devices using a Language-promptable Digital Twin](https://mlsanity.com/paper/2412.08020/) (2024)

## Abstract (arXiv)

The ability to synthesize realistic X-ray images has catalyzed the development of AI models for X-ray image-guided procedures, which otherwise suffer from a lack of available annotated data. Prior work has demonstrated the effectiveness of mechanistic simulation of digitally reconstructed radiographs (DRRs) as a training data source for a myriad of tasks, including segmentation and anatomical landmark detection, with comparable or superior performance to real data training. However, mechanistic DRR synthesis still relies on the availability of annotated high-resolution anatomical models. Deriving these from CT images of real patients or specimens imposes an undesirable bottleneck on data quantity and variability. In this work, we explore two methods for synthesizing training data: (1) a 3D conditional latent diffusion model that generates CT volumes to use as inputs for mechanistic DRR generation without real, 3D anatomical models, and (2) a view-conditioned 2D diffusion model that produces synthetic X-rays. In controlled experiments, we demonstrate that synthetic 2D diffusion-based X-rays can be used to train an anatomical landmark detection model that generalized to real X-ray images with performance rivaling that of a model trained on real X-ray images. Thus, we provide preliminary evidence that synthetic, 2D diffusion-based training data can substitute for real X-ray data, identifying a promising avenue towards generating large, diverse datasets for training robust AI models in interventional X-ray imaging.