arXiv:2510.07681v1 Announce Type: cross Abstract: This study evaluates whether integrating curriculum learning with diffusion-based synthetic augmentation can enhance the detection of difficult pulmonary nodules in chest radiographs, particularly those with low size, brightness, and contrast, which often challenge conventional AI models due to data imbalance and limited annotation. A Faster R-CNN with a Feature Pyramid Network (FPN) backbone was trained on a hybrid dataset comprising expert-labeled NODE21 (1,213 patients; 52.4 percent male; mean age 63.2 +/- 11.5 years), VinDr-CXR, CheXpert, and 11,206 DDPM-generated synthetic images. Difficulty scores based on size, brightness, and contrast guided curriculum learning. Performance was compared to a non-curriculum baseline using mean average precision (mAP), Dice score, and area under the curve (AUC). Statistical tests included bootstrapped confidence intervals, DeLong tests, and paired t-tests. The curriculum model achieved a mean AUC of 0.95 versus 0.89 for the baseline (p < 0.001), with improvements in sensitivity (70 percent vs. 48 percent) and accuracy (82 percent vs. 70 percent). Stratified analysis demonstrated consistent gains across all difficulty bins (Easy to Very Hard). Grad-CAM visualizations confirmed more anatomically focused attention under curriculum learning. These results suggest that curriculum-guided synthetic augmentation enhances model robustness and generalization for pulmonary nodule detection.
