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The results show that exploiting paired anatomical correspondence enables diffusion-level LDCT reconstruction with a single step reconstruction, and across all REFM variants, one-step inference consistently provides the highest reconstruction quality.
Self-supervised pretraining enables transferable representations for medical imaging, yet most CT encoders remain biased toward coarse semantic understanding, limiting their sensitivity to fine-grained anatomical structures such as vessels or small tumors. In this paper, we introduce Biased Masked Image Modeling (B-MIM), a modification of the iBOT objective that stochastically reduces global semantic alignment to prioritize local patch reconstruction. This bias encourages the encoder to capture high-frequency morphological details and structural continuity. We curate a multi-institutional CT abdominal dataset of 9,955 filtered studies from 17 public sources and pretrain a 3D Swin Transformer backbone using B-MIM. Across inter-dataset experiments on liver vessel segmentation, the proposed encoder improves topological fidelity (clDice) and achieves competitive Dice scores in tumor segmentation, compared to fully fine-tuned baselines, despite updating only a fraction of the parameters. Our results suggest that reducing global semantic pressure during pretraining enhances generalization to intricate anatomical structures.
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