RELICT: A Replica Detection Framework for Medical Image Generation

Despite the potential of synthetic medical data for augmenting and improving the generalizability of deep learning models, memorization in generative models can lead to unintended leakage of sensitive patient information and limit model utility. Thus, the use of memorizing generative models in the medical domain can jeopardize patient privacy. We propose a framework for identifying replicas, i.e. nearly identical copies of the training data, in synthetic medical image datasets. Our REpLIca deteCTion (RELICT) framework for medical image generative models evaluates image similarity using three complementary approaches: (1) voxel-level analysis, (2) feature-level analysis by a pretrained medical foundation model, and (3) segmentation-level analysis. Two clinically relevant 3D generative modelling use cases were investigated: non-contrast head CT with intracerebral hemorrhage (N=774) and time-of-flight MR angiography of the Circle of Willis (N=1,782). Expert visual scoring was used as the reference standard to assess the presence of replicas. We report the balanced accuracy at the optimal threshold to assess replica classification performance. The reference visual rating identified 45 of 50 and 5 of 50 generated images as replicas for the NCCT and TOF-MRA use cases, respectively. Image-level and feature-level measures perfectly classified replicas with a balanced accuracy of 1 when an optimal threshold was selected for the NCCT use case. A perfect classification of replicas for the TOF-MRA case was not possible at any threshold, with the segmentation-level analysis achieving a balanced accuracy of 0.79. Replica detection is a crucial but neglected validation step for the development of generative models in medical imaging. The proposed RELICT framework provides a standardized, easy-to-use tool for replica detection and aims to facilitate responsible and ethical medical image synthesis.