ECG-Image-Database: A Dataset of ECG Images with Real-World Imaging and Scanning Artifacts; A Foundation for Computerized ECG Image Digitization and Analysis

We introduce the ECG-Image-Database, a large and diverse collection of electrocardiogram (ECG) images generated from ECG time-series data, with real-world scanning, imaging, and physical artifacts. We used ECG-Image-Kit, an open-source Python toolkit, to generate realistic images of 12-lead ECG printouts from raw ECG time-series. The images include realistic distortions such as noise, wrinkles, stains, and perspective shifts, generated both digitally and physically. The toolkit was applied to 977 12-lead ECG records from the PTB-XL database and 1,000 from Emory Healthcare to create high-fidelity synthetic ECG images. These unique images were subjected to both programmatic distortions using ECG-Image-Kit and physical effects like soaking, staining, and mold growth, followed by scanning and photography under various lighting conditions to create real-world artifacts. The resulting dataset includes 35,595 software-labeled ECG images with a wide range of imaging artifacts and distortions. The dataset provides ground truth time-series data alongside the images, offering a reference for developing machine and deep learning models for ECG digitization and classification. The images vary in quality, from clear scans of clean papers to noisy photographs of degraded papers, enabling the development of more generalizable digitization algorithms. ECG-Image-Database addresses a critical need for digitizing paper-based and non-digital ECGs for computerized analysis, providing a foundation for developing robust machine and deep learning models capable of converting ECG images into time-series. The dataset aims to serve as a reference for ECG digitization and computerized annotation efforts. ECG-Image-Database was used in the PhysioNet Challenge 2024 on ECG image digitization and classification.

A Synthetic Electrocardiogram (ECG) Image Generation Toolbox to Facilitate Deep Learning-Based Scanned ECG Digitization

The electrocardiogram (ECG) is an accurate and widely available tool for diagnosing cardiovascular diseases. ECGs have been recorded in printed formats for decades and their digitization holds great potential for training machine learning (ML) models in algorithmic ECG diagnosis. Physical ECG archives are at risk of deterioration and scanning printed ECGs alone is insufficient, as ML models require ECG time-series data. Therefore, the digitization and conversion of paper ECG archives into time-series data is of utmost importance. Deep learning models for image processing show promise in this regard. However, the scarcity of ECG archives with reference time-series is a challenge. Data augmentation techniques utilizing \textit{digital twins} present a potential solution. We introduce a novel method for generating synthetic ECG images on standard paper-like ECG backgrounds with realistic artifacts. Distortions including handwritten text artifacts, wrinkles, creases and perspective transforms are applied to the generated images, without personally identifiable information. As a use case, we generated an ECG image dataset of 21,801 records from the 12-lead PhysioNet PTB-XL ECG time-series dataset. A deep ECG image digitization model was built and trained on the synthetic dataset, and was employed to convert the synthetic images to time-series data for evaluation. The signal-to-noise ratio (SNR) was calculated to assess the image digitization quality vs the ground truth ECG time-series. The results show an average signal recovery SNR of 27$\pm$2.8\,dB, demonstrating the significance of the proposed synthetic ECG image dataset for training deep learning models. The codebase is available as an open-access toolbox for ECG research.