Abstract
Synthetic X-ray angiographies generated by modern generative models hold great potential to reduce the use of contrast agents in vascular interventional procedures. However, low-quality synthetic angiographies can significantly increase procedural risk, underscoring the need for reliable image quality assessment (IQA) methods. Existing IQA models, however, fail to leverage auxiliary images as references during evaluation and lack fine-grained, task-specific metrics necessary for clinical relevance. To address these limitations, this paper proposes CAS-IQA, a vision-language model (VLM)-based framework that predicts fine-grained quality scores by effectively incorporating auxiliary information from related images. In the absence of angiography datasets, CAS-3K is constructed, comprising 3,565 synthetic angiographies along with score annotations. To ensure clinically meaningful assessment, three task-specific evaluation metrics are defined. Furthermore, a Multi-path featUre fuSion and ro