This paper presents a comprehensive systematic review of generative models (GANs, VAEs, DMs, and LLMs) used to synthesize various medical data types, including imaging (dermoscopic, mammographic, ultrasound, CT, MRI, and X-ray), text, time-series, and tabular data (EHR). Unlike previous narrowly focused reviews, our study encompasses a broad array of medical data modalities and explores various generative models. Our aim is to offer insights into their current and future applications in medical research, particularly in the context of synthesis applications, generation techniques, and evaluation methods, as well as providing a GitHub repository as a dynamic resource for ongoing collaboration and innovation. Our search strategy queries databases such as Scopus, PubMed, and ArXiv, focusing on recent works from January 2021 to November 2023, excluding reviews and perspectives. This period emphasizes recent advancements beyond GANs, which have been extensively covered in previous reviews. The survey also emphasizes the aspect of conditional generation, which is not focused on in similar work. Key contributions include a broad, multi-modality scope that identifies cross-modality insights and opportunities unavailable in single-modality surveys. While core generative techniques are transferable, we find that synthesis methods often lack sufficient integration of patient-specific context, clinical knowledge, and modality-specific requirements tailored to the unique characteristics of medical data. Conditional models leveraging textual conditioning and multimodal synthesis remain underexplored but offer promising directions for innovation. Our findings are structured around three themes: (1) Synthesis applications, highlighting clinically valid synthesis applications and significant gaps in using synthetic data beyond augmentation, such as for validation and evaluation; (2) Generation techniques, identifying gaps in personalization and cross-modality innovation; and (3) Evaluation methods, revealing the absence of standardized benchmarks, the need for large-scale validation, and the importance of privacy-aware, clinically relevant evaluation frameworks. These findings emphasize the need for benchmarking and comparative studies to promote openness and collaboration.

In recent years, several deep learning models have been proposed to accurately quantify and diagnose cardiac pathologies. These automated tools heavily rely on the accurate segmentation of cardiac structures in MRI images. However, segmentation of the right ventricle is challenging due to its highly complex shape and ill-defined borders. Hence, there is a need for new methods to handle such structure's geometrical and textural complexities, notably in the presence of pathologies such as Dilated Right Ventricle, Tricuspid Regurgitation, Arrhythmogenesis, Tetralogy of Fallot, and Inter-atrial Communication. The last MICCAI challenge on right ventricle segmentation was held in 2012 and included only 48 cases from a single clinical center. As part of the 12 ^th Workshop on Statistical Atlases and Computational Models of the Heart (STACOM 2021), the M&Ms-2 challenge was organized to promote the interest of the research community around right ventricle segmentation in multi-disease, multi-view, and multi-center cardiac MRI. Three hundred sixty CMR cases, including short-axis and long-axis 4-chamber views, were collected from three Spanish hospitals using nine different scanners from three different vendors, and included a diverse set of right and left ventricle pathologies. The solutions provided by the participants show that nnU-Net achieved the best results overall. However, multi-view approaches were able to capture additional information, highlighting the need to integrate multiple cardiac diseases, views, scanners, and acquisition protocols to produce reliable automatic cardiac segmentation algorithms.

Deep learning-based segmentation methods provide an effective and automated way for assessing the structure and function of the heart in cardiac magnetic resonance (CMR) images. However, despite their state-of-the-art performance on images acquired from the same source (same scanner or scanner vendor) as images used during training, their performance degrades significantly on images coming from different domains. A straightforward approach to tackle this issue consists of acquiring large quantities of multi-site and multi-vendor data, which is practically infeasible. Generative adversarial networks (GANs) for image synthesis present a promising solution for tackling data limitations in medical imaging and addressing the generalization capability of segmentation models. In this work, we explore the usability of synthesized short-axis CMR images generated using a segmentation-informed conditional GAN, to improve the robustness of heart cavity segmentation models in a variety of different settings. The GAN is trained on paired real images and corresponding segmentation maps belonging to both the heart and the surrounding tissue, reinforcing the synthesis of semantically-consistent and realistic images. First, we evaluate the segmentation performance of a model trained solely with synthetic data and show that it only slightly underperforms compared to the baseline trained with real data. By further combining real with synthetic data during training, we observe a substantial improvement in segmentation performance (up to 4% and 40% in terms of Dice score and Hausdorff distance) across multiple data-sets collected from various sites and scanner. This is additionally demonstrated across state-of-the-art 2D and 3D segmentation networks, whereby the obtained results demonstrate the potential of the proposed method in tackling the presence of the domain shift in medical data. Finally, we thoroughly analyze the quality of synthetic data and its ability to replace real MR images during training, as well as provide an insight into important aspects of utilizing synthetic images for segmentation.

Synthesis of a large set of high-quality medical images with variability in anatomical representation and image appearance has the potential to provide solutions for tackling the scarcity of properly annotated data in medical image analysis research. In this paper, we propose a novel framework consisting of image segmentation and synthesis based on mask-conditional GANs for generating high-fidelity and diverse Cardiac Magnetic Resonance (CMR) images. The framework consists of two modules: i) a segmentation module trained using a physics-based simulated database of CMR images to provide multi-tissue labels on real CMR images, and ii) a synthesis module trained using pairs of real CMR images and corresponding multi-tissue labels, to translate input segmentation masks to realistic-looking cardiac images. The anatomy of synthesized images is based on labels, whereas the appearance is learned from the training images. We investigate the effects of the number of tissue labels, quantity of training data, and multi-vendor data on the quality of the synthesized images. Furthermore, we evaluate the effectiveness and usability of the synthetic data for a downstream task of training a deep-learning model for cardiac cavity segmentation in the scenarios of data replacement and augmentation. The results of the replacement study indicate that segmentation models trained with only synthetic data can achieve comparable performance to the baseline model trained with real data, indicating that the synthetic data captures the essential characteristics of its real counterpart. Furthermore, we demonstrate that augmenting real with synthetic data during training can significantly improve both the Dice score (maximum increase of 4%) and Hausdorff Distance (maximum reduction of 40%) for cavity segmentation, suggesting a good potential to aid in tackling medical data scarcity.

Cardiac magnetic resonance (CMR) image segmentation is an integral step in the analysis of cardiac function and diagnosis of heart related diseases. While recent deep learning-based approaches in automatic segmentation have shown great promise to alleviate the need for manual segmentation, most of these are not applicable to realistic clinical scenarios. This is largely due to training on mainly homogeneous datasets, without variation in acquisition, which typically occurs in multi-vendor and multi-site settings, as well as pathological data. Such approaches frequently exhibit a degradation in prediction performance, particularly on outlier cases commonly associated with difficult pathologies, artifacts and extensive changes in tissue shape and appearance. In this work, we present a model aimed at segmenting all three cardiac structures in a multi-center, multi-disease and multi-view scenario. We propose a pipeline, addressing different challenges with segmentation of such heterogeneous data, consisting of heart region detection, augmentation through image synthesis and a late-fusion segmentation approach. Extensive experiments and analysis demonstrate the ability of the proposed approach to tackle the presence of outlier cases during both training and testing, allowing for better adaptation to unseen and difficult examples. Overall, we show that the effective reduction of segmentation failures on outlier cases has a positive impact on not only the average segmentation performance, but also on the estimation of clinical parameters, leading to a better consistency in derived metrics.

Foundation models have revolutionized computer vision by achieving vastly superior performance across diverse tasks through large-scale pretraining on extensive datasets. However, their application in surgical computer vision has been limited. This study addresses this gap by introducing SurgeNetXL, a novel surgical foundation model that sets a new benchmark in surgical computer vision. Trained on the largest reported surgical dataset to date, comprising over 4.7 million video frames, SurgeNetXL achieves consistent top-tier performance across six datasets spanning four surgical procedures and three tasks, including semantic segmentation, surgical phase recognition, and critical view of safety (CVS) classification. Compared with the best-performing surgical foundation model, SurgeNetXL shows mean improvements of 4.0 %, 8.9 %, and 11.4 % for semantic segmentation, phase recognition, and CVS classification, respectively. Additionally, SurgeNetXL outperforms ImageNet1k by 16.1 %, 8.0 %, and 4.3 % for the respective tasks. In addition to advancing model performance, this study provides key insights into scaling pretraining datasets, extending training durations, and optimizing model architectures specifically for surgical computer vision. These findings pave the way for improved generalization and robustness in data-scarce scenarios, offering a comprehensive framework for future research in this domain. All models and a subset of the SurgeNetXL dataset, including over 2 million video frames, are publicly available at: https://github.com/TimJaspers0801/SurgeNet.