VolDiT: Controllable Volumetric Medical Image Synthesis with Diffusion Transformers

Diffusion models have become a leading approach for high-fidelity medical image synthesis. However, most existing methods for 3D medical image generation rely on convolutional U-Net backbones within latent diffusion frameworks. While effective, these architectures impose strong locality biases and limited receptive fields, which may constrain scalability, global context integration, and flexible conditioning. In this work, we introduce VolDiT, the first purely transformer-based 3D Diffusion Transformer for volumetric medical image synthesis. Our approach extends diffusion transformers to native 3D data through volumetric patch embeddings and global self-attention operating directly over 3D tokens. To enable structured control, we propose a timestep-gated control adapter that maps segmentation masks into learnable control tokens that modulate transformer layers during denoising. This token-level conditioning mechanism allows precise spatial guidance while preserving the modeling advantages of transformer architectures. We evaluate our model on high-resolution 3D medical image synthesis tasks and compare it to state-of-the-art 3D latent diffusion models based on U-Nets. Results demonstrate improved global coherence, superior generative fidelity, and enhanced controllability. Our findings suggest that fully transformerbased diffusion models provide a flexible foundation for volumetric medical image synthesis. The code and models trained on public data are available at https://github.com/Cardio-AI/voldit.

CardioDiT: Latent Diffusion Transformers for 4D Cardiac MRI Synthesis

Latent diffusion models (LDMs) have recently achieved strong performance in 3D medical image synthesis. However, modalities like cine cardiac MRI (CMR), representing a temporally synchronized 3D volume across the cardiac cycle, add an additional dimension that most generative approaches do not model directly. Instead, they factorize space and time or enforce temporal consistency through auxiliary mechanisms such as anatomical masks. Such strategies introduce structural biases that may limit global context integration and lead to subtle spatiotemporal discontinuities or physiologically inconsistent cardiac dynamics. We investigate whether a unified 4D generative model can learn continuous cardiac dynamics without architectural factorization. We propose CardioDiT, a fully 4D latent diffusion framework for short-axis cine CMR synthesis based on diffusion transformers. A spatiotemporal VQ-VAE encodes 2D+t slices into compact latents, which a diffusion transformer then models jointly as complete 3D+t volumes, coupling space and time throughout the generative process. We evaluate CardioDiT on public CMR datasets and a larger private cohort, comparing it to baselines with progressively stronger spatiotemporal coupling. Results show improved inter-slice consistency, temporally coherent motion, and realistic cardiac function distributions, suggesting that explicit 4D modeling with a diffusion transformer provides a principled foundation for spatiotemporal cardiac image synthesis. Code and models trained on public data are available at https://github.com/Cardio-AI/cardiodit.

MedLoRD: A Medical Low-Resource Diffusion Model for High-Resolution 3D CT Image Synthesis

Advancements in AI for medical imaging offer significant potential. However, their applications are constrained by the limited availability of data and the reluctance of medical centers to share it due to patient privacy concerns. Generative models present a promising solution by creating synthetic data as a substitute for real patient data. However, medical images are typically high-dimensional, and current state-of-the-art methods are often impractical for computational resource-constrained healthcare environments. These models rely on data sub-sampling, raising doubts about their feasibility and real-world applicability. Furthermore, many of these models are evaluated on quantitative metrics that alone can be misleading in assessing the image quality and clinical meaningfulness of the generated images. To address this, we introduce MedLoRD, a generative diffusion model designed for computational resource-constrained environments. MedLoRD is capable of generating high-dimensional medical volumes with resolutions up to 512$\times$512$\times$256, utilizing GPUs with only 24GB VRAM, which are commonly found in standard desktop workstations. MedLoRD is evaluated across multiple modalities, including Coronary Computed Tomography Angiography and Lung Computed Tomography datasets. Extensive evaluations through radiological evaluation, relative regional volume analysis, adherence to conditional masks, and downstream tasks show that MedLoRD generates high-fidelity images closely adhering to segmentation mask conditions, surpassing the capabilities of current state-of-the-art generative models for medical image synthesis in computational resource-constrained environments.

Arbitrary Data as Images: Fusion of Patient Data Across Modalities and Irregular Intervals with Vision Transformers

A patient undergoes multiple examinations in each hospital stay, where each provides different facets of the health status. These assessments include temporal data with varying sampling rates, discrete single-point measurements, therapeutic interventions such as medication administration, and images. While physicians are able to process and integrate diverse modalities intuitively, neural networks need specific modeling for each modality complicating the training procedure. We demonstrate that this complexity can be significantly reduced by visualizing all information as images along with unstructured text and subsequently training a conventional vision-text transformer. Our approach, Vision Transformer for irregular sampled Multi-modal Measurements (ViTiMM), not only simplifies data preprocessing and modeling but also outperforms current state-of-the-art methods in predicting in-hospital mortality and phenotyping, as evaluated on 6,175 patients from the MIMIC-IV dataset. The modalities include patient's clinical measurements, medications, X-ray images, and electrocardiography scans. We hope our work inspires advancements in multi-modal medical AI by reducing the training complexity to (visual) prompt engineering, thus lowering entry barriers and enabling no-code solutions for training. The source code will be made publicly available.

Latent Pollution Model: The Hidden Carbon Footprint in 3D Image Synthesis

Contemporary developments in generative AI are rapidly transforming the field of medical AI. These developments have been predominantly driven by the availability of large datasets and high computing power, which have facilitated a significant increase in model capacity. Despite their considerable potential, these models demand substantially high power, leading to high carbon dioxide (CO2) emissions. Given the harm such models are causing to the environment, there has been little focus on the carbon footprints of such models. This study analyzes carbon emissions from 2D and 3D latent diffusion models (LDMs) during training and data generation phases, revealing a surprising finding: the synthesis of large images contributes most significantly to these emissions. We assess different scenarios including model sizes, image dimensions, distributed training, and data generation steps. Our findings reveal substantial carbon emissions from these models, with training 2D and 3D models comparable to driving a car for 10 km and 90 km, respectively. The process of data generation is even more significant, with CO2 emissions equivalent to driving 160 km for 2D models and driving for up to 3345 km for 3D synthesis. Additionally, we found that the location of the experiment can increase carbon emissions by up to 94 times, and even the time of year can influence emissions by up to 50%. These figures are alarming, considering they represent only a single training and data generation phase for each model. Our results emphasize the urgent need for developing environmentally sustainable strategies in generative AI.

Multi-Modal Dataset Creation for Federated~Learning with DICOM Structured Reports

Purpose: Federated training is often hindered by heterogeneous datasets due to divergent data storage options, inconsistent naming schemes, varied annotation procedures, and disparities in label quality. This is particularly evident in the emerging multi-modal learning paradigms, where dataset harmonization including a uniform data representation and filtering options are of paramount importance. Methods: DICOM structured reports enable the standardized linkage of arbitrary information beyond the imaging domain and can be used within Python deep learning pipelines with highdicom. Building on this, we developed an open platform for data integration and interactive filtering capabilities that simplifies the process of assembling multi-modal datasets. Results: In this study, we extend our prior work by showing its applicability to more and divergent data types, as well as streamlining datasets for federated training within an established consortium of eight university hospitals in Germany. We prove its concurrent filtering ability by creating harmonized multi-modal datasets across all locations for predicting the outcome after minimally invasive heart valve replacement. The data includes DICOM data (i.e. computed tomography images, electrocardiography scans) as well as annotations (i.e. calcification segmentations, pointsets and pacemaker dependency), and metadata (i.e. prosthesis and diagnoses). Conclusion: Structured reports bridge the traditional gap between imaging systems and information systems. Utilizing the inherent DICOM reference system arbitrary data types can be queried concurrently to create meaningful cohorts for clinical studies. The graphical interface as well as example structured report templates will be made publicly available.

Federated Foundation Model for Cardiac CT Imaging

Federated learning (FL) is a renowned technique for utilizing decentralized data while preserving privacy. However, real-world applications often involve inherent challenges such as partially labeled datasets, where not all clients possess expert annotations of all labels of interest, leaving large portions of unlabeled data unused. In this study, we conduct the largest federated cardiac CT imaging analysis to date, focusing on partially labeled datasets ($n=8,124$) of Transcatheter Aortic Valve Implantation (TAVI) patients over eight hospital clients. Transformer architectures, which are the major building blocks of current foundation models, have shown superior performance when trained on larger cohorts than traditional CNNs. However, when trained on small task-specific labeled sample sizes, it is currently not feasible to exploit their underlying attention mechanism for improved performance. Therefore, we developed a two-stage semi-supervised learning strategy that distills knowledge from several task-specific CNNs (landmark detection and segmentation of calcification) into a single transformer model by utilizing large amounts of unlabeled data typically residing unused in hospitals to mitigate these issues. This method not only improves the predictive accuracy and generalizability of transformer-based architectures but also facilitates the simultaneous learning of all partial labels within a single transformer model across the federation. Additionally, we show that our transformer-based model extracts more meaningful features for further downstream tasks than the UNet-based one by only training the last layer to also solve segmentation of coronary arteries. We make the code and weights of the final model openly available, which can serve as a foundation model for further research in cardiac CT imaging.

FUNAvg: Federated Uncertainty Weighted Averaging for Datasets with Diverse Labels

Federated learning is one popular paradigm to train a joint model in a distributed, privacy-preserving environment. But partial annotations pose an obstacle meaning that categories of labels are heterogeneous over clients. We propose to learn a joint backbone in a federated manner, while each site receives its own multi-label segmentation head. By using Bayesian techniques we observe that the different segmentation heads although only trained on the individual client's labels also learn information about the other labels not present at the respective site. This information is encoded in their predictive uncertainty. To obtain a final prediction we leverage this uncertainty and perform a weighted averaging of the ensemble of distributed segmentation heads, which allows us to segment "locally unknown" structures. With our method, which we refer to as FUNAvg, we are even on-par with the models trained and tested on the same dataset on average. The code is publicly available at https://github.com/Cardio-AI/FUNAvg.

Unconditional Latent Diffusion Models Memorize Patient Imaging Data

Generative latent diffusion models hold a wide range of applications in the medical imaging domain. A noteworthy application is privacy-preserved open-data sharing by proposing synthetic data as surrogates of real patient data. Despite the promise, these models are susceptible to patient data memorization, where models generate patient data copies instead of novel synthetic samples. This undermines the whole purpose of preserving patient data and may even result in patient re-identification. Considering the importance of the problem, surprisingly it has received relatively little attention in the medical imaging community. To this end, we assess memorization in latent diffusion models for medical image synthesis. We train 2D and 3D latent diffusion models on CT, MR, and X-ray datasets for synthetic data generation. Afterwards, we examine the amount of training data memorized utilizing self-supervised models and further investigate various factors that can possibly lead to memorization by training models in different settings. We observe a surprisingly large amount of data memorization among all datasets, with up to 41.7%, 19.6%, and 32.6% of the training data memorized in CT, MRI, and X-ray datasets respectively. Further analyses reveal that increasing training data size and using data augmentation reduce memorization, while over-training enhances it. Overall, our results suggest a call for memorization-informed evaluation of synthetic data prior to open-data sharing.

Investigating Data Memorization in 3D Latent Diffusion Models for Medical Image Synthesis

Generative latent diffusion models have been established as state-of-the-art in data generation. One promising application is generation of realistic synthetic medical imaging data for open data sharing without compromising patient privacy. Despite the promise, the capacity of such models to memorize sensitive patient training data and synthesize samples showing high resemblance to training data samples is relatively unexplored. Here, we assess the memorization capacity of 3D latent diffusion models on photon-counting coronary computed tomography angiography and knee magnetic resonance imaging datasets. To detect potential memorization of training samples, we utilize self-supervised models based on contrastive learning. Our results suggest that such latent diffusion models indeed memorize training data, and there is a dire need for devising strategies to mitigate memorization.