  Ultrasound imaging makes use of backscattering of waves during their
interaction with scatterers present in biological tissues. Simulation of
synthetic ultrasound images is a challenging problem on account of inability to
accurately model various factors of which some include intra-/inter scanline
interference, transducer to surface coupling, artifacts on transducer elements,
inhomogeneous shadowing and nonlinear attenuation. Current approaches typically
solve wave space equations making them computationally expensive and slow to
operate. We propose a generative adversarial network (GAN) inspired approach
for fast simulation of patho-realistic ultrasound images. We apply the
framework to intravascular ultrasound (IVUS) simulation. A stage 0 simulation
performed using pseudo B-mode ultrasound image simulator yields speckle mapping
of a digitally defined phantom. The stage I GAN subsequently refines them to
preserve tissue specific speckle intensities. The stage II GAN further refines
them to generate high resolution images with patho-realistic speckle profiles.
We evaluate patho-realism of simulated images with a visual Turing test
indicating an equivocal confusion in discriminating simulated from real. We
also quantify the shift in tissue specific intensity distributions of the real
and simulated images to prove their similarity.
