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This book constitutes the refereed proceedings of the Third International Workshop on Simulation and Synthesis in Medical Imaging, SASHIMI 2018, held in conjunction with MICCAI 2018, in Granada, Spain, in September 2018.The 14 full papers presented were carefully reviewed and selected from numerous submissions. This workshop continues to provide a state-of-the-art and integrative perspective on simulation and synthesis in medical imaging for the purpose of invigorating research and stimulating new ideas on how to build theoretical links, practical synergies, and best practices between these two research directions.