In medical imaging, access to data is commonly limited due to patient privacy restrictions, and it can be difficult to acquire enough data in the case of rare diseases. The purpose of this investigation was to develop a reusable open-source synthetic image-generation pipeline, the GAN Image Synthesis Tool (GIST), that is easy to use as well as easy to deploy. The pipeline helps to improve and standardize AI algorithms in the digital health space by generating high quality synthetic image data that is not linked to specific patients. Its image generation capabilities include the ability to generate imaging of pathologies or injuries with low incidence rates. This improvement of digital health AI algorithms could improve diagnostic accuracy, aid in patient care, decrease medicolegal claims, and ultimately decrease the overall cost of healthcare. The pipeline builds on existing Generative Adversarial Networks (GANs) algorithms, and preprocessing and evaluation steps were included for completeness. For this work, we focused on ensuring the pipeline supports radiography, with a focus on synthetic knee and elbow X-ray images. In designing the pipeline, we evaluated the performance of current GAN architectures, studying the performance on available X-ray data. We show that the pipeline is capable of generating high-quality and clinically relevant images based on a lay person’s evaluation and the Fréchet Inception Distance (FID) metric.

The “Coherent Data Set” is a novel synthetic data set that leverages structured data from Synthea™ to create a longitudinal, “coherent” patient-level electronic health record (EHR). Comprised of synthetic patients, the Coherent Data Set is publicly available, reproducible using Synthea™, and free of the privacy risks that arise from using real patient data. The Coherent Data Set provides complex and representative health records that can be leveraged by health IT professionals without the risks associated with de-identified patient data. It includes familial genomes that were created through a simulation of the genetic reproduction process; magnetic resonance imaging (MRI) DICOM files created with a voxel-based computational model; clinical notes in the style of traditional subjective, objective, assessment, and plan notes; and physiological data that leverage existing System Biology Markup Language (SBML) models to capture non-linear changes in patient health metrics. HL7 Fast Healthcare Interoperability Resources (FHIR^®) links the data together. The models can generate clinically logical health data, but ensuring clinical validity remains a challenge without comparable data to substantiate results. We believe this data set is the first of its kind and a novel contribution to practical health interoperability efforts.