Generative methods have reached a level of quality that is almost indistinguishable from real data. However, while individual samples may appear unique, generative models often exhibit limitations in covering the full data distribution. Unlike quality issues, diversity problems within generative models are not easily detected by simply observing single images or generated datasets, which means we need a specific measure to assess the diversity of these models. In this paper, we draw attention to the current lack of diversity in generative models and the inability of common metrics to measure this. We achieve this by framing diversity as an image retrieval problem, where we measure how many real images can be retrieved using synthetic data as queries. This yields the Image Retrieval Score (IRS), an interpretable, hyperparameter-free metric that quantifies the diversity of a generative model’s output. IRS requires only a subset of synthetic samples and provides a statistical measure of confidence. Our experiments indicate that current feature extractors commonly used in generative model assessment are inadequate for evaluating diversity effectively. Consequently, we perform an extensive search for the best feature extractors to assess diversity. Evaluation reveals that current diffusion models converge to limited subsets of the real distribution, with no current state-of-the-art models superpassing 77% of the diversity of the training data. To address this limitation, we introduce Diversity-Aware Diffusion Models (DiADM), a novel approach that improves diversity of unconditional diffusion models without loss of image quality. We do this by disentangling diversity from image quality by using a diversity aware module that uses pseudo-unconditional features as input. We provide a Python package offering unified feature extraction and metric computation to further facilitate the evaluation of generative models https://github.com/MischaD/beyondfid.

Recent progress in vision-language modeling for 3D medical imaging has been fueled by large-scale computed tomography (CT) corpora with paired free-text reports, stronger architectures, and powerful pretrained models. This has enabled applications such as automated report generation and text-conditioned 3D image synthesis. Yet, current approaches struggle with high-resolution, long-sequence volumes: contrastive pretraining often yields vision encoders that are misaligned with clinical language, and slice-wise tokenization blurs fine anatomy, reducing diagnostic performance on downstream tasks. We introduce BTB3D (Better Tokens for Better 3D), a causal convolutional encoder-decoder that unifies 2D and 3D training and inference while producing compact, frequency-aware volumetric tokens. A three-stage training curriculum enables (i) local reconstruction, (ii) overlapping-window tiling, and (iii) long-context decoder refinement, during which the model learns from short slice excerpts yet generalizes to scans exceeding $300$ slices without additional memory overhead. BTB3D sets a new state-of-the-art on two key tasks: it improves BLEU scores and increases clinical F1 by 40\% over CT2Rep, CT-CHAT, and Merlin for report generation; and it reduces FID by 75\% and halves FVD compared to GenerateCT and MedSyn for text-to-CT synthesis, producing anatomically consistent $512\times512\times241$ volumes. These results confirm that precise three-dimensional tokenization, rather than larger language backbones alone, is essential for scalable vision-language modeling in 3D medical imaging. The codebase is available at: https://github.com/ibrahimethemhamamci/BTB3D

Recent advancements in diffusion models have significantly impacted the trajectory of generative machine learning re-search, with many adopting the strategy of fine-tuning pre-trained models using domain-specific text-to-image datasets. Notably, this method has been readily employed for medical applications, such as X-ray image synthesis, leveraging the plethora of associated radiology reports. Yet, a prevailing concern is the lack of assurance on whether these models genuinely comprehend their generated content. With the evolution of text conditional image generation, these models have grown potent enough to facilitate object localization scrutiny. Our research underscores this advancement in the critical realm of medical imaging, emphasizing the crucial role of interpretability. We further unravel a consequential trade-off between image fidelity – as gauged by conventional metrics – and model interpretability in generative diffusion models. Specifically, the adoption of learnable text encoders when fine-tuning results in diminished interpretability. Our in-depth exploration uncovers the underlying factors responsible for this divergence. Consequently, we present a set of design principles for the development of truly interpretable generative models. Code is available at https://github.com/MischaD/chest-distillation.

Curating datasets for object segmentation is a difficult task. With the advent of large-scale pre-trained generative models, conditional image generation has been given a significant boost in result quality and ease of use. In this paper, we present a novel method that enables the generation of general foreground-background segmentation models from simple textual descriptions, without requiring segmentation labels. We leverage and explore pre-trained latent diffusion models, to automatically generate weak segmentation masks for concepts and objects. The masks are then used to fine-tune the diffusion model on an inpainting task, which enables fine-grained removal of the object, while at the same time providing a synthetic foreground and background dataset. We demonstrate that using this method beats previous methods in both discriminative and generative performance and closes the gap with fully supervised training while requiring no pixel-wise object labels. We show results on the task of segmenting four different objects (humans, dogs, cars, birds) and a use case scenario in medical image analysis. The code is available at https://github.com/MischaD/fobadiffusion.