Clinical Evaluation of Medical Image Synthesis: A Case Study in Wireless Capsule Endoscopy

Sharing retrospectively acquired data is essential for both clinical research and training. Synthetic Data Generation (SDG), using Artificial Intelligence (AI) models, can overcome privacy barriers in sharing clinical data, enabling advancements in medical diagnostics. This study focuses on the clinical evaluation of medical SDG, with a proof-of-concept investigation on diagnosing Inflammatory Bowel Disease (IBD) using Wireless Capsule Endoscopy (WCE) images. The paper contributes by a) presenting a protocol for the systematic evaluation of synthetic images by medical experts and b) applying it to assess TIDE-II, a novel variational autoencoder-based model for high-resolution WCE image synthesis, with a comprehensive qualitative evaluation conducted by 10 international WCE specialists, focusing on image quality, diversity, realism, and clinical decision-making. The results show that TIDE-II generates clinically relevant WCE images, helping to address data scarcity and enhance diagnostic tools. The proposed protocol serves as a reference for future research on medical image-generation techniques.

This Intestine Does Not Exist: Multiscale Residual Variational Autoencoder for Realistic Wireless Capsule Endoscopy Image Generation

Medical image synthesis has emerged as a promising solution to address the limited availability of annotated medical data needed for training machine learning algorithms in the context of image-based Clinical Decision Support (CDS) systems. To this end, Generative Adversarial Networks (GANs) have been mainly applied to support the algorithm training process by generating synthetic images for data augmentation. However, in the field of Wireless Capsule Endoscopy (WCE), the limited content diversity and size of existing publicly available annotated datasets, adversely affect both the training stability and synthesis performance of GANs. Aiming to a viable solution for WCE image synthesis, a novel Variational Autoencoder architecture is proposed, namely "This Intestine Does not Exist" (TIDE). The proposed architecture comprises multiscale feature extraction convolutional blocks and residual connections, which enable the generation of high-quality and diverse datasets even with a limited number of training images. Contrary to the current approaches, which are oriented towards the augmentation of the available datasets, this study demonstrates that using TIDE, real WCE datasets can be fully substituted by artificially generated ones, without compromising classification performance. Furthermore, qualitative and user evaluation studies by experienced WCE specialists, validate from a medical viewpoint that both the normal and abnormal WCE images synthesized by TIDE are sufficiently realistic.