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Diffusion Models for Medical Image Analysis: A Comprehensive Survey

Denoising diffusion models, a class of generative models, have garnered immense interest lately in various deep-learning problems. A diffusion probabilistic model defines a forward diffusion stage where the input data is gradually perturbed over several steps by adding Gaussian noise and then learns to reverse the diffusion process to retrieve the desired noise-free data from noisy data samples. Diffusion models are widely appreciated for their strong mode coverage and quality of the generated samples despite their known computational burdens. Capitalizing on the advances in computer vision, the field of medical imaging has also observed a growing interest in diffusion models. To help the researcher navigate this profusion, this survey intends to provide a comprehensive overview of diffusion models in the discipline of medical image analysis. Specifically, we introduce the solid theoretical foundation and fundamental concepts behind diffusion models and the three generic diffusion modelling frameworks: diffusion probabilistic models, noise-conditioned score networks, and stochastic differential equations. Then, we provide a systematic taxonomy of diffusion models in the medical domain and propose a multi-perspective categorization based on their application, imaging modality, organ of interest, and algorithms. To this end, we cover extensive applications of diffusion models in the medical domain. Furthermore, we emphasize the practical use case of some selected approaches, and then we discuss the limitations of the diffusion models in the medical domain and propose several directions to fulfill the demands of this field. Finally, we gather the overviewed studies with their available open-source implementations at https://github.com/amirhossein-kz/Awesome-Diffusion-Models-in-Medical-Imaging.

Tackling the Generative Learning Trilemma with Denoising Diffusion GANs

A wide variety of deep generative models has been developed in the past decade. Yet, these models often struggle with simultaneously addressing three key requirements including: high sample quality, mode coverage, and fast sampling. We call the challenge imposed by these requirements the generative learning trilemma, as the existing models often trade some of them for others. Particularly, denoising diffusion models have shown impressive sample quality and diversity, but their expensive sampling does not yet allow them to be applied in many real-world applications. In this paper, we argue that slow sampling in these models is fundamentally attributed to the Gaussian assumption in the denoising step which is justified only for small step sizes. To enable denoising with large steps, and hence, to reduce the total number of denoising steps, we propose to model the denoising distribution using a complex multimodal distribution. We introduce denoising diffusion generative adversarial networks (denoising diffusion GANs) that model each denoising step using a multimodal conditional GAN. Through extensive evaluations, we show that denoising diffusion GANs obtain sample quality and diversity competitive with original diffusion models while being 2000times faster on the CIFAR-10 dataset. Compared to traditional GANs, our model exhibits better mode coverage and sample diversity. To the best of our knowledge, denoising diffusion GAN is the first model that reduces sampling cost in diffusion models to an extent that allows them to be applied to real-world applications inexpensively. Project page and code can be found at https://nvlabs.github.io/denoising-diffusion-gan

RadRotator: 3D Rotation of Radiographs with Diffusion Models

Transforming two-dimensional (2D) images into three-dimensional (3D) volumes is a well-known yet challenging problem for the computer vision community. In the medical domain, a few previous studies attempted to convert two or more input radiographs into computed tomography (CT) volumes. Following their effort, we introduce a diffusion model-based technology that can rotate the anatomical content of any input radiograph in 3D space, potentially enabling the visualization of the entire anatomical content of the radiograph from any viewpoint in 3D. Similar to previous studies, we used CT volumes to create Digitally Reconstructed Radiographs (DRRs) as the training data for our model. However, we addressed two significant limitations encountered in previous studies: 1. We utilized conditional diffusion models with classifier-free guidance instead of Generative Adversarial Networks (GANs) to achieve higher mode coverage and improved output image quality, with the only trade-off being slower inference time, which is often less critical in medical applications; and 2. We demonstrated that the unreliable output of style transfer deep learning (DL) models, such as Cycle-GAN, to transfer the style of actual radiographs to DRRs could be replaced with a simple yet effective training transformation that randomly changes the pixel intensity histograms of the input and ground-truth imaging data during training. This transformation makes the diffusion model agnostic to any distribution variations of the input data pixel intensity, enabling the reliable training of a DL model on input DRRs and applying the exact same model to conventional radiographs (or DRRs) during inference.

One-step Diffusion Models with $f$-Divergence Distribution Matching

Sampling from diffusion models involves a slow iterative process that hinders their practical deployment, especially for interactive applications. To accelerate generation speed, recent approaches distill a multi-step diffusion model into a single-step student generator via variational score distillation, which matches the distribution of samples generated by the student to the teacher's distribution. However, these approaches use the reverse Kullback-Leibler (KL) divergence for distribution matching which is known to be mode seeking. In this paper, we generalize the distribution matching approach using a novel f-divergence minimization framework, termed f-distill, that covers different divergences with different trade-offs in terms of mode coverage and training variance. We derive the gradient of the f-divergence between the teacher and student distributions and show that it is expressed as the product of their score differences and a weighting function determined by their density ratio. This weighting function naturally emphasizes samples with higher density in the teacher distribution, when using a less mode-seeking divergence. We observe that the popular variational score distillation approach using the reverse-KL divergence is a special case within our framework. Empirically, we demonstrate that alternative f-divergences, such as forward-KL and Jensen-Shannon divergences, outperform the current best variational score distillation methods across image generation tasks. In particular, when using Jensen-Shannon divergence, f-distill achieves current state-of-the-art one-step generation performance on ImageNet64 and zero-shot text-to-image generation on MS-COCO. Project page: https://research.nvidia.com/labs/genair/f-distill

Solving 3D Inverse Problems using Pre-trained 2D Diffusion Models

Diffusion models have emerged as the new state-of-the-art generative model with high quality samples, with intriguing properties such as mode coverage and high flexibility. They have also been shown to be effective inverse problem solvers, acting as the prior of the distribution, while the information of the forward model can be granted at the sampling stage. Nonetheless, as the generative process remains in the same high dimensional (i.e. identical to data dimension) space, the models have not been extended to 3D inverse problems due to the extremely high memory and computational cost. In this paper, we combine the ideas from the conventional model-based iterative reconstruction with the modern diffusion models, which leads to a highly effective method for solving 3D medical image reconstruction tasks such as sparse-view tomography, limited angle tomography, compressed sensing MRI from pre-trained 2D diffusion models. In essence, we propose to augment the 2D diffusion prior with a model-based prior in the remaining direction at test time, such that one can achieve coherent reconstructions across all dimensions. Our method can be run in a single commodity GPU, and establishes the new state-of-the-art, showing that the proposed method can perform reconstructions of high fidelity and accuracy even in the most extreme cases (e.g. 2-view 3D tomography). We further reveal that the generalization capacity of the proposed method is surprisingly high, and can be used to reconstruct volumes that are entirely different from the training dataset.

SAGE-RT: Synthetic Alignment data Generation for Safety Evaluation and Red Teaming

We introduce Synthetic Alignment data Generation for Safety Evaluation and Red Teaming (SAGE-RT or SAGE) a novel pipeline for generating synthetic alignment and red-teaming data. Existing methods fall short in creating nuanced and diverse datasets, providing necessary control over the data generation and validation processes, or require large amount of manually generated seed data. SAGE addresses these limitations by using a detailed taxonomy to produce safety-alignment and red-teaming data across a wide range of topics. We generated 51,000 diverse and in-depth prompt-response pairs, encompassing over 1,500 topics of harmfulness and covering variations of the most frequent types of jailbreaking prompts faced by large language models (LLMs). We show that the red-teaming data generated through SAGE jailbreaks state-of-the-art LLMs in more than 27 out of 32 sub-categories, and in more than 58 out of 279 leaf-categories (sub-sub categories). The attack success rate for GPT-4o, GPT-3.5-turbo is 100% over the sub-categories of harmfulness. Our approach avoids the pitfalls of synthetic safety-training data generation such as mode collapse and lack of nuance in the generation pipeline by ensuring a detailed coverage of harmful topics using iterative expansion of the topics and conditioning the outputs on the generated raw-text. This method can be used to generate red-teaming and alignment data for LLM Safety completely synthetically to make LLMs safer or for red-teaming the models over a diverse range of topics.

MoDeGPT: Modular Decomposition for Large Language Model Compression

Large Language Models (LLMs) have reshaped the landscape of artificial intelligence by demonstrating exceptional performance across various tasks. However, substantial computational requirements make their deployment challenging on devices with limited resources. Recently, compression methods using low-rank matrix techniques have shown promise, yet these often lead to degraded accuracy or introduce significant overhead in parameters and inference latency. This paper introduces Modular Decomposition (MoDeGPT), a novel structured compression framework that does not need recovery fine-tuning while resolving the above drawbacks. MoDeGPT partitions the Transformer block into modules comprised of matrix pairs and reduces the hidden dimensions via reconstructing the module-level outputs. MoDeGPT is developed based on a theoretical framework that utilizes three well-established matrix decomposition algorithms -- Nystr\"om approximation, CR decomposition, and SVD -- and applies them to our redefined transformer modules. Our comprehensive experiments show MoDeGPT, without backward propagation, matches or surpasses previous structured compression methods that rely on gradient information, and saves 98% of compute costs on compressing a 13B model. On Llama-2/3 and OPT models, MoDeGPT maintains 90-95% zero-shot performance with 25-30% compression rates. Moreover, the compression can be done on a single GPU within a few hours and increases the inference throughput by up to 46%.

Efficient Diffusion Transformer Policies with Mixture of Expert Denoisers for Multitask Learning

Diffusion Policies have become widely used in Imitation Learning, offering several appealing properties, such as generating multimodal and discontinuous behavior. As models are becoming larger to capture more complex capabilities, their computational demands increase, as shown by recent scaling laws. Therefore, continuing with the current architectures will present a computational roadblock. To address this gap, we propose Mixture-of-Denoising Experts (MoDE) as a novel policy for Imitation Learning. MoDE surpasses current state-of-the-art Transformer-based Diffusion Policies while enabling parameter-efficient scaling through sparse experts and noise-conditioned routing, reducing both active parameters by 40% and inference costs by 90% via expert caching. Our architecture combines this efficient scaling with noise-conditioned self-attention mechanism, enabling more effective denoising across different noise levels. MoDE achieves state-of-the-art performance on 134 tasks in four established imitation learning benchmarks (CALVIN and LIBERO). Notably, by pretraining MoDE on diverse robotics data, we achieve 4.01 on CALVIN ABC and 0.95 on LIBERO-90. It surpasses both CNN-based and Transformer Diffusion Policies by an average of 57% across 4 benchmarks, while using 90% fewer FLOPs and fewer active parameters compared to default Diffusion Transformer architectures. Furthermore, we conduct comprehensive ablations on MoDE's components, providing insights for designing efficient and scalable Transformer architectures for Diffusion Policies. Code and demonstrations are available at https://mbreuss.github.io/MoDE_Diffusion_Policy/.