# Spatially Gated Diffusion for Localized Counterfactual Chest Radiograph Editing

arXiv: https://arxiv.org/abs/2610.00805 · HTML: https://mlsanity.com/paper/2610.00805/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 21 of its 25 references that are in the map.
- First posted on arXiv 30 Sep 2026.

## Builds on (most cited first, 21 of 21)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Denoising Diffusion Implicit Models](https://mlsanity.com/paper/2010.02502/) (2020)
- [SDXL: Improving Latent Diffusion Models for High-Resolution Image Synthesis](https://mlsanity.com/paper/2307.01952/) (2023)
- [InstructPix2Pix: Learning to Follow Image Editing Instructions](https://mlsanity.com/paper/2211.09800/) (2022)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Attention is not Explanation](https://mlsanity.com/paper/1902.10186/) (2019)
- [DiffEdit: Diffusion-based semantic image editing with mask guidance](https://mlsanity.com/paper/2210.11427/) (2022)
- [Blended Latent Diffusion](https://mlsanity.com/paper/2206.02779/) (2022)
- [Making the Most of Text Semantics to Improve Biomedical Vision--Language Processing](https://mlsanity.com/paper/2204.09817/) (2022)
- [What the DAAM: Interpreting Stable Diffusion Using Cross Attention](https://mlsanity.com/paper/2210.04885/) (2022)
- [Deep Structural Causal Models for Tractable Counterfactual Inference](https://mlsanity.com/paper/2006.06485/) (2020)
- [Metrics reloaded: Recommendations for image analysis validation](https://mlsanity.com/paper/2206.01653/) (2022)
- [BiomedJourney: Counterfactual Biomedical Image Generation by Instruction-Learning from Multimodal Patient Journeys](https://mlsanity.com/paper/2310.10765/) (2023)
- [RadEdit: stress-testing biomedical vision models via diffusion image editing](https://mlsanity.com/paper/2312.12865/) (2023)
- [PRISM: High-Resolution & Precise Counterfactual Medical Image Generation using Language-guided Stable Diffusion](https://mlsanity.com/paper/2503.00196/) (2025)
- [MedEBench: Diagnosing Reliability in Text-Guided Medical Image Editing](https://mlsanity.com/paper/2506.01921/) (2025)
- [Causal-Adapter: Taming Text-to-Image Diffusion for Faithful Counterfactual Generation](https://mlsanity.com/paper/2509.24798/) (2025)
- [Mask-Guided Attention Regulation for Anatomically Consistent Counterfactual CXR Synthesis](https://mlsanity.com/paper/2603.04130/) (2026)
- [Generating Chest X-Ray Counterfactuals by Specialising Foundation Image Models](https://mlsanity.com/paper/2609.24879/) (2026)

## Abstract (arXiv)

Editing a chest radiograph requires completing the requested change while preserving unrelated content. We study a latent diffusion editor with an instruction-independent source trajectory and an instruction-conditioned editing trajectory. A learned gate mixes their post-sampler candidates at each executed step, and a separate image-space mask composites the decoded proposal with the source. On 2,400 MIMIC-derived requests, 2,244 outputs met the joint target, preservation, quality, and coverage rubric (93.5%), and target completion was 97.4%. Joint validity exceeded a matched composition-only control by 1.7 percentage points (paired patient-cluster 95% interval, 0.6--2.8). At a fixed learned mask, the learned-gate proposal improved joint validity by 1.6 points (0.8--2.4); at a fixed learned proposal, the learned mask improved it by 2.6 points (1.7--3.5). Across three training seeds, mean joint validity was 93.5% with a 0.3-point sample standard deviation. A blinded 240-request assessment yielded adjudicated joint validity of 93.3% for the full editor and 91.7% for composition only. Protected-region mean absolute error decreased from 0.0190 in the raw proposal to 0.0075 after composition. These findings distinguish recurrent-gating effects on the proposal from preservation through final composition in the assessed cohort.