LightRefine-PCXR: A Lightweight Refinement Framework for Efficient Medical Device Suppression in Pediatric Chest X-Rays

In pediatric chest radiography, indwelling support devices (e.g., tubes and lines) are ubiq uitous and often obscure critical thoracic structures, complicating radiologic interpretation and reducing the reliability of automated analysis methods. Although generative inpainting has advanced rapidly, reliable deployment in pediatric chest radiographs remains challeng ing. Subtle anatomical cues must be preserved under substantial domain shift, while full adaptation of large backbones is often impractical because of limited pediatric data and constrained clinical compute budgets. To address these limitations, we propose LightRefine PCXR, a lightweight, backbone-agnostic refinement framework for suppressing medical de vices in pediatric chest X-rays (PCXRs). LightRefine-PCXR follows a two-stage strategy: a frozen pretrained inpainting backbone first produces a coarse device-removed estimate, and a compact anatomy-aware refiner then predicts mask-constrained residual corrections to restore local structures while preserving all unmasked pixels exactly. This plug-in design substantially reduces trainable parameters and peak GPU memory compared with end-to end fine-tuning, yet consistently improves reconstruction fidelity and perceptual quality across diverse inpainting paradigms, including CNN-, transformer-, and diffusion-based models. Comprehensive in-domain and cross-dataset experiments demonstrate robust de vice suppression and strong generalization in low-data pediatric settings, highlighting the practicality of LightRefine-PCXR for real-world pediatric radiology workflows. Our model will be publicly available upon acceptance.

Recommended citation: Mingze Jiang, Xueyang Li, John Kheir, Alec Girten, and Yiyu Shi. (2026). "LightRefine-PCXR: A Lightweight Refinement Framework for Efficient Medical Device Suppression in Pediatric Chest X-Rays." Medical Imaging with Deep Learning (MIDL).
Download Paper