There has been increasing interest in the generation of high-quality, realistic synthetic medical images in recent years. Such synthetic datasets can mitigate the scarcity of public datasets for artificial intelligence research, and can also be used for educational purposes. In this paper, we propose a combination of diffusion-based generation (PanoDiff) and Super-Resolution (SR) for generating synthetic dental panoramic radiographs (PRs). The former generates a low-resolution (LR) seed of a PR (256 X 128) which is then processed by the SR model to yield a high-resolution (HR) PR of size 1024 X 512. For SR, we propose a state-of-the-art transformer that learns local-global relationships, resulting in sharper edges and textures. Experimental results demonstrate a Frechet inception distance score of 40.69 between 7243 real and synthetic images (in HR). Inception scores were 2.55, 2.30, 2.90 and 2.98 for real HR, synthetic HR, real LR and synthetic LR images, respectively. Among a diverse group of six clinical experts, all evaluating a mixture of 100 synthetic and 100 real PRs in a time-limited observation, the average accuracy in distinguishing real from synthetic images was 68.5% (with 50% corresponding to random guessing).

Accurate targeting is critical for the effectiveness of transcranial focused ultrasound (tFUS) neuromodulation. While CT provides accurate skull acoustic properties, its ionizing radiation and poor soft tissue contrast limit clinical applicability. In contrast, MRI offers superior neuroanatomical visualization without radiation exposure but lacks skull property mapping. This study proposes a novel, fully CT free simulation framework that integrates MRI-derived synthetic CT (sCT) with efficient modeling techniques for rapid and precise tFUS targeting. We trained a deep-learning model to generate sCT from T1-weighted MRI and integrated it with both full-wave (k-Wave) and accelerated simulation methods, hybrid angular spectrum (kWASM) and Rayleigh-Sommerfeld ASM (RSASM). Across five skull models, both full-wave and hybrid pipelines using sCT demonstrated sub-millimeter targeting deviation, focal shape consistency (FWHM ~3.3-3.8 mm), and <0.2 normalized pressure error compared to CT-based gold standard. Notably, the kW-ASM and RS-ASM pipelines reduced simulation time from ~3320 s to 187 s and 34 s respectively, achieving ~94% and ~90% time savings. These results confirm that MRI-derived sCT combined with innovative rapid simulation techniques enables fast, accurate, and radiation-free tFUS planning, supporting its feasibility for scalable clinical applications.

Purpose: Ultra-high-field 7T MRI offers improved resolution and contrast over standard clinical field strengths (1.5T, 3T). However, 7T scanners are costly, scarce, and introduce additional challenges such as susceptibility artifacts. We propose an efficient transformer-based model (7T-Restormer) to synthesize 7T-quality T1-maps from routine 1.5T or 3T T1-weighted (T1W) images. Methods: Our model was validated on 35 1.5T and 108 3T T1w MRI paired with corresponding 7T T1 maps of patients with confirmed MS. A total of 141 patient cases (32,128 slices) were randomly divided into 105 (25; 80) training cases (19,204 slices), 19 (5; 14) validation cases (3,476 slices), and 17 (5; 14) test cases (3,145 slices) where (X; Y) denotes the patients with 1.5T and 3T T1W scans, respectively. The synthetic 7T T1 maps were compared against the ResViT and ResShift models. Results: The 7T-Restormer model achieved a PSNR of 26.0 +/- 4.6 dB, SSIM of 0.861 +/- 0.072, and NMSE of 0.019 +/- 0.011 for 1.5T inputs, and 25.9 +/- 4.9 dB, and 0.866 +/- 0.077 for 3T inputs, respectively. Using 10.5 M parameters, our model reduced NMSE by 64 % relative to 56.7M parameter ResShift (0.019 vs 0.052, p = <.001 and by 41 % relative to 70.4M parameter ResViT (0.019 vs 0.032, p = <.001) at 1.5T, with similar advantages at 3T (0.021 vs 0.060 and 0.033; p < .001). Training with a mixed 1.5 T + 3 T corpus was superior to single-field strategies. Restricting the model to 1.5T increased the 1.5T NMSE from 0.019 to 0.021 (p = 1.1E-3) while training solely on 3T resulted in lower performance on input 1.5T T1W MRI. Conclusion: We propose a novel method for predicting quantitative 7T MP2RAGE maps from 1.5T and 3T T1W scans with higher quality than existing state-of-the-art methods. Our approach makes the benefits of 7T MRI more accessible to standard clinical workflows.

The development of robust deep learning models for breast ultrasound (BUS) image analysis is significantly constrained by the scarcity of expert-annotated data. To address this limitation, we propose a clinically controllable generative framework for synthesizing BUS images. This framework integrates clinical descriptions with structural masks to generate tumors, enabling fine-grained control over tumor characteristics such as morphology, echogencity, and shape. Furthermore, we design a semantic-curvature mask generator, which synthesizes structurally diverse tumor masks guided by clinical priors. During inference, synthetic tumor masks serve as input to the generative framework, producing highly personalized synthetic BUS images with tumors that reflect real-world morphological diversity. Quantitative evaluations on six public BUS datasets demonstrate the significant clinical utility of our synthetic images, showing their effectiveness in enhancing downstream breast cancer diagnosis tasks. Furthermore, visual Turing tests conducted by experienced sonographers confirm the realism of the generated images, indicating the framework's potential to support broader clinical applications.

Objective: Latent diffusion models (LDMs) could mitigate data scarcity challenges affecting machine learning development for medical image interpretation. The recent CCELLA LDM improved prostate cancer detection performance using synthetic MRI for classifier training but was limited to the axial T2-weighted (AxT2) sequence, did not investigate inter-institutional domain shift, and prioritized radiology over histopathology outcomes. We propose CCELLA++ to address these limitations and improve clinical utility. Methods: CCELLA++ expands CCELLA for simultaneous biparametric prostate MRI (bpMRI) generation, including the AxT2, high b-value diffusion series (HighB) and apparent diffusion coefficient map (ADC). Domain adaptation was investigated by pretraining classifiers on real or LDM-generated synthetic data from an internal institution, followed with fine-tuning on progressively smaller fractions of an out-of-distribution, external dataset. Results: CCELLA++ improved 3D FID for HighB and ADC but not AxT2 (0.013, 0.012, 0.063 respectively) sequences compared to CCELLA (0.060). Classifier pretraining with CCELLA++ bpMRI outperformed real bpMRI in AP and AUC for all domain adaptation scenarios. CCELLA++ pretraining achieved highest classifier performance below 50% (n=665) external dataset volume. Conclusion: Synthetic bpMRI generated by our method can improve downstream classifier generalization and performance beyond real bpMRI or CCELLA-generated AxT2-only images. Future work should seek to quantify medical image sample quality, balance multi-sequence LDM training, and condition the LDM with additional information. Significance: The proposed CCELLA++ LDM can generate synthetic bpMRI that outperforms real data for domain adaptation with a limited target institution dataset. Our code is available at https://github.com/grabkeem/CCELLA-plus-plus

We evaluated sCT generated from T2-weighted imaging (T2WI) using deep learning techniques to detect structural lesions in lumbar facet arthritis, with conventional CT as the reference standard. This single-center retrospective study included 40 patients who had lumbar MRI and CT with in 1 week (September 2020 to August 2021). A Pix2Pix-GAN framework generated CT images from MRI data, and image quality was assessed using structural similarity index (SSIM), mean absolute error (MAE), peak signal-to-noise ratio (PSNR), nd Dice similarity coefficient (DSC). Two senior radiologists evaluated 15 anatomical landmarks. Sensitivity, specificity, and accuracy for detecting bone erosion, osteosclerosis, and joint space alterations were analyzed for sCT, T2-weighted MRI, and conventional CT. Forty participants (21 men, 19 women) were enrolled, with a mean age of 39 ± 16.9 years. sCT showed strong agreement with conventional CT, with SSIM values of 0.888 for axial and 0.889 for sagittal views. PSNR and MAE values were 24.56 dB and 0.031 for axial and 23.75 dB and 0.038 for sagittal views, respectively. DSC values were 0.935 for axial and 0.876 for sagittal views. sCT showed excellent intra- and inter-reader reliability intraclass correlation coefficients (0.953-0.995 and 0.839-0.983, respectively). sCT had higher sensitivity (57.9% vs. 5.3%), specificity (98.8% vs. 84.6%), and accuracy (93.0% vs. 73.3%) for bone erosion than T2-weighted MRI and outperformed it for osteosclerosis and joint space changes. sCT outperformed conventional T2-weighted MRI in detecting structural lesions indicative of lumbar facet arthritis, with conventional CT as the reference standard.

Accurate MR signal simulation, including microvascular structures and water diffusion, is crucial for MRI techniques like fMRI BOLD modeling and MR vascular Fingerprinting (MRF), which use susceptibility effects on MR signals for tissue characterization. However, integrating microvascular features and diffusion remains computationally challenging, limiting the accuracy of the estimates. Using advanced modeling and deep neural networks, we propose a novel simulation tool that efficiently accounts for susceptibility and diffusion effects. We used dimension reduction of magnetic field inhomogeneity matrices combined with deep learning methodology to accelerate the simulations while maintaining their accuracy. We validated our results through an in silico study against a reference method and in vivo MRF experiments. This approach accelerates MR signal generation by a factor of almost 13 000 compared to previously used simulation methods while preserving accuracy. The MR-WAVES method allows fast generation of MR signals accounting for microvascular structures and water-diffusion contribution.

Education for medical imaging technologists or radiographers in regional and rural areas often faces significant challenges due to limited financial, technological, and teaching resources. Generative AI presents a promising solution to overcome these barriers and support the professional development of radiographers. This pilot study aimed to evaluate the educational value of an in-house AI-based imaging simulation tool designed to generate clinically relevant medical images for professional training purposes. In July 2023, a professional development lecture featuring AI-generated clinical imaging content was delivered to students (N = 122/130) and recent graduates (N = 155/532), alongside a pre-lecture survey. Following the session, participants completed a questionnaire comprising structured and open-ended items to assess their understanding, perceptions, and interest in AI within medical imaging education. Survey results indicated that both students and graduates possessed a foundational awareness of AI applications in medical imaging. Graduates demonstrated significantly higher expectations for clinical realism in AI-generated simulations, likely reflecting their clinical experience. Although the simulator's current capabilities are limited in replicating complex diagnostic imaging, participants acknowledged its pedagogical value, particularly in supporting basic anatomical education. Approximately 50% of respondents expressed interest in further developing their AI knowledge and contributing to the research and development of AI-based educational tools. AI-driven imaging simulation tools have the potential to enhance radiography education and reduce teaching barriers. While further development is needed to improve clinical fidelity, such tools can play a valuable role in foundational training and foster learner engagement in AI innovation.

Organ motion is a limiting factor during the treatment of abdominal tumors. During abdominal interventions, medical images are acquired to provide guidance, however, this increases operative time and radiation exposure. In this paper, conditional generative adversarial networks are implemented to generate dynamic magnetic resonance images using external abdominal motion as a surrogate signal. The generator was trained to account for breathing variability, and different models were investigated to improve motion quality. Additionally, an objective and subjective study were conducted to assess image and motion quality. The objective study included different metrics, such as structural similarity index measure (SSIM) and mean absolute error (MAE). In the subjective study, 32 clinical experts participated in evaluating the generated images by completing different tasks. The tasks involved identifying images and videos as real or fake, via a questionnaire allowing experts to assess the realism in static images and dynamic sequences. The results of the best-performing model displayed an SSIM of 0.73 ± 0.13, and the MAE was below 4.5 and 1.8 mm for the superior-inferior and anterior-posterior directions of motion. The proposed framework was compared to a related method that utilized a set of convolutional neural networks combined with recurrent layers. In the subjective study, more than 50% of the generated images and dynamic sequences were classified as real, except for one task. Synthetic images have the potential to reduce the need for acquiring intraoperative images, decreasing time and radiation exposure. A video summary can be found in the supplementary material.

X-ray imaging is a rapid and cost-effective tool for visualizing internal human anatomy. While multi-view X-ray imaging provides complementary information that enhances diagnosis, intervention, and education, acquiring images from multiple angles increases radiation exposure and complicates clinical workflows. To address these challenges, we propose a novel view-conditioned diffusion model for synthesizing multi-view X-ray images from a single view. Unlike prior methods, which are limited in angular range, resolution, and image quality, our approach leverages the Diffusion Transformer to preserve fine details and employs a weak-to-strong training strategy for stable high-resolution image generation. Experimental results demonstrate that our method generates higher-resolution outputs with improved control over viewing angles. This capability has significant implications not only for clinical applications but also for medical education and data extension, enabling the creation of diverse, high-quality datasets for training and analysis. Our code is available at GitHub.