On the notion of Hallucinations from the lens of Bias and Validity in Synthetic CXR Images

Medical imaging has revolutionized disease diagnosis, yet the potential is hampered by limited access to diverse and privacy-conscious datasets. Open-source medical datasets, while valuable, suffer from data quality and clinical information disparities. Generative models, such as diffusion models, aim to mitigate these challenges. At Stanford, researchers explored the utility of a fine-tuned Stable Diffusion model (RoentGen) for medical imaging data augmentation. Our work examines specific considerations to expand the Stanford research question, Could Stable Diffusion Solve a Gap in Medical Imaging Data? from the lens of bias and validity of the generated outcomes. We leveraged RoentGen to produce synthetic Chest-XRay (CXR) images and conducted assessments on bias, validity, and hallucinations. Diagnostic accuracy was evaluated by a disease classifier, while a COVID classifier uncovered latent hallucinations. The bias analysis unveiled disparities in classification performance among various subgroups, with a pronounced impact on the Female Hispanic subgroup. Furthermore, incorporating race and gender into input prompts exacerbated fairness issues in the generated images. The quality of synthetic images exhibited variability, particularly in certain disease classes, where there was more significant uncertainty compared to the original images. Additionally, we observed latent hallucinations, with approximately 42% of the images incorrectly indicating COVID, hinting at the presence of hallucinatory elements. These identifications provide new research directions towards interpretability of synthetic CXR images, for further understanding of associated risks and patient safety in medical applications.