A Conditional Flow Variational Autoencoder for Controllable Synthesis of Virtual Populations of Anatomy

Generating virtual populations (VPs) of anatomy is essential for conducting in-silico trials of medical devices. Typically, the generated VP should capture sufficient variability while remaining plausible, and should reflect specific characteristics and patient demographics observed in real populations. It is desirable in several applications to synthesize VPs in a \textit{controlled} manner, where relevant covariates are used to conditionally synthesise virtual populations that fit specific target patient populations/characteristics. We propose to equip a conditional variational autoencoder (cVAE) with normalizing flows to boost the flexibility and complexity of the approximate posterior learned, leading to enhanced flexibility for controllable synthesis of VPs of anatomical structures. We demonstrate the performance of our conditional-flow VAE using a dataset of cardiac left ventricles acquired from 2360 patients, with associated demographic information and clinical measurements (used as covariates/conditioning information). The obtained results indicate the superiority of the proposed method for conditional synthesis of virtual populations of cardiac left ventricles relative to a cVAE. Conditional synthesis performance was assessed in terms of generalisation and specificity errors, and in terms of the ability to preserve clinical relevant biomarkers in the synthesised VPs, I.e. left ventricular blood pool and myocardial volume, relative to the observed real population.