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

Access to medical data is often limited as it contains protected health information (PHI). There are privacy concerns regarding using records containing personally identifiable information. Recent advancements have been made in applying deep learning-based algorithms for clinical diagnosis and decision-making. However, deep learning models are data-greedy, whereas the availability of medical datasets for training and evaluating these models is relatively limited. Data augmentation with so-called \textit{digital twins} is an emerging technique to address this need. This paper presents a novel approach for generating synthetic electrocardiogram (ECG) images with realistic artifacts from time-series data for use in developing algorithms for digitization of ECG images. Synthetic data is generated in a privacy-preserving manner by generating distortionless ECG images on standard ECG paper background. Next, various distortions, including handwritten text artifacts, wrinkles, creases, and perspective transforms are applied to the ECG images. The artifacts are generated synthetically, without personally identifiable information. As a use case, we generated a large ECG image dataset of 21,801 records from the PhysioNet PTB-XL dataset, with 12 lead ECG time-series data from 18,869 patients. A deep ECG image digitization model was developed 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.